Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | OS017547 | PA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 20A16235 | CA |
NPI | 1033405246 |
---|---|
Provider Name | Dr. James Laurence Bedell |
First Address | Modesto, CA 95356-9718 |
Second Address | Modesto, CA 95356-9718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2011 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103014610 | (05) | PA |