Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | A93330 | CA |
N | 208000000X | Pediatrician | A93830 | CA |
NPI | 1629101126 |
---|---|
Provider Name | Dr. Daniel Lee Imler |
First Address | Boston, MA 02118-2908 |
Second Address | Stanford, CA 94305-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 04/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A933300 | (05) | CA |
I70981 | (02) | CA |