Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G47295 | CA |
N | 111NI0900X | Internist | G47295 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | G47295 | CA |
N | 207RR0500X | Rheumatology | G47295 | CA |
NPI | 1255396594 |
---|---|
Provider Name | Dr. Edward J. Goetzl |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0G4729500 | (05) | CA |
A50648 | (02) | CA |