Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | G142100 | CA |
NPI | 1053328575 |
---|---|
Provider Name | Dr. James L Poth JR. |
First Address | Santa Cruz, CA 95060-1608 |
Second Address | Santa Cruz, CA 95060-1608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 18/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A29197 | (02) |