Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 264035 | NY |
N | 2081S0010X | Sports Medicine | 052447 | CT |
N | 213ES0000X | Sports Medicine | 052447 | CT |
Y | 2081S0010X | Sports Medicine | 20A18060 | CA |
Y | 213ES0000X | Sports Medicine | 20A18060 | CA |
NPI | 1316258304 |
---|---|
Provider Name | Dr. Gene Tekmyster |
First Address | Los Angeles, CA 90031-0309 |
Second Address | El Segundo, CA 90245-2818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 07/09/2020 |