Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G61618 | CA |
Y | 111NI0900X | Internist | G61618 | CA |
N | 207RH0000X | Hematologist | G61618 | CA |
N | 207RX0202X | Medical Oncology | G61618 | CA |
NPI | 1437117454 |
---|---|
Provider Name | Dr. Eric J. Small |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94115-3010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 20/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0G6161800 | (05) | CA |
E88475 | (02) | CA |