Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | D19585 | CA |
NPI | 1184836702 |
---|---|
Provider Name | Dr. John E. Beumer III |
First Address | Los Angeles, CA 90073-0582 |
Second Address | Los Angeles, CA 90095-3075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 26/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G91297-01 | (05) | CA |