Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 24944 | OR |
Y | 2086S0129X | Vascular Surgeon | A77313 | CA |
NPI | 1174528889 |
---|---|
Provider Name | Dr. Jeffry D Cardneau |
First Address | San Rafael, CA 94903-3308 |
Second Address | San Rafael, CA 94903-3308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H57740 | (02) | OR |