Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 3158 | NV |
NPI | 1073573689 |
---|---|
Provider Name | Dr. James Thomas Breeden |
First Address | Carson City, NV 89703-3821 |
Second Address | Carson City, NV 89703-3821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 07/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002013102 | (05) | NV |
C95823 | (02) | NV |