Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | AFE24931 | CA |
NPI | 1073915831 |
---|---|
Provider Name | Dr. Edward W. Tam |
First Address | Redding, CA 96001-0151 |
Second Address | Redding, CA 96001-0151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2014 |
Last Update Date | 23/09/2014 |