Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 20A8894 | CA |
NPI | 1023009297 |
---|---|
Provider Name | Dr. David R Gotham JR. |
First Address | Rocklin, CA 95765-4413 |
Second Address | Rocklin, CA 95765-4413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 07/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00AX88940 | (05) | CA |
I14198 | (02) | CA |