Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E3227 | CA |
NPI | 1114055654 |
---|---|
Provider Name | Dr. David Stuart Ullman |
First Address | Woodland Hills, CA 91367-6518 |
Second Address | Woodland Hills, CA 91367-6518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E3227 | STATE LICENSE NUMBER CA. (01) | CA |
T19284 | (02) | CA |