Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 31174 | CA |
NPI | 1346359973 |
---|---|
Provider Name | Dr. Frederick C Rutherford |
First Address | Los Angeles, CA 90059 |
Second Address | Los Angeles, CA 90059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T70471 | (02) | CA |