Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC27451 | CA |
NPI | 1093854283 |
---|---|
Provider Name | Dr. Edward Dewey Jennings |
First Address | Sacramento, CA 95821-3372 |
Second Address | Sacramento, CA 95825-3273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 27/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T67038 | (02) | CA |