Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A6889 | CA |
NPI | 1093803983 |
---|---|
Provider Name | Dr. Jeffrey Etemad |
First Address | Mill Valley, CA 94941-3034 |
Second Address | Mill Valley, CA 94941-3034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G92026 | (02) | CA |