Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G66004 | CA |
NPI | 1275560484 |
---|---|
Provider Name | Dr. David Frederick Shirley |
First Address | Rocklin, CA 95765-5554 |
Second Address | Rocklin, CA 95765-5554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E29236 | (02) |