Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G64478 | CA |
NPI | 1053403774 |
---|---|
Provider Name | Dr. Craig Wesley Canfield |
First Address | San Luis Obispo, CA 93401-7329 |
Second Address | San Luis Obispo, CA 93405-5803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 21/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G644780 | (05) | CA |
F49464 | (02) | CA |