Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 255304 | NY |
Y | 207SG0201X | Clinical Genetics (M.D.) | A92750 | CA |
NPI | 1548548548 |
---|---|
Provider Name | Dr. Brandon Ross Colby |
First Address | Los Angeles, CA 90025-4749 |
Second Address | Los Angeles, CA 90025-4749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2011 |
Last Update Date | 26/07/2011 |