Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | G28169 | CA |
NPI | 1194785758 |
---|---|
Provider Name | Dr. John A Demersseman |
First Address | Palm Springs, CA 92262-5750 |
Second Address | Palm Springs, CA 92262-5750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A43636 | (02) | CA |