Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G62677 | CA |
N | 208600000X | Surgeon | G62677 | CA |
Y | 2082S0105X | Plastic Hand Surgeon | G62677 | CA |
NPI | 1952340176 |
---|---|
Provider Name | Dr. James L Pertsch |
First Address | San Mateo, CA 94401-2807 |
Second Address | San Mateo, CA 94401-2807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 31/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E89328 | (02) | CA |