Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000E37430 | CA |
Y | 222Z00000X | Podiatrist | 000E37430 | CA |
NPI | 1023120565 |
---|---|
Provider Name | Dr. Charles J Starrett |
First Address | San Francisco, CA 94117 |
Second Address | San Francisco, CA 94117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 16/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U12648 | (02) |