Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 58981 | CA |
NPI | 1437479144 |
---|---|
Provider Name | Dr. Brian Robert Carr |
First Address | San Francisco, CA 94117-3862 |
Second Address | San Francisco, CA 94143-0440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 03/06/2010 |