Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E2041 | CA |
NPI | 1063871234 |
---|---|
Provider Name | Dr. Gregory W Herb |
First Address | San Jose, CA 95123-2349 |
Second Address | San Jose, CA 95123-2349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2016 |
Last Update Date | 17/02/2016 |