Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 35882 | CA |
NPI | 1063733228 |
---|---|
Provider Name | Dr. Jeffrey S Fleming |
First Address | Redding, CA 96002 |
Second Address | Redding, CA 96002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 17/03/2015 |