Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | G062311 | CA |
NPI | 1124001417 |
---|---|
Provider Name | Dr. Jonathan Mark Ducore |
First Address | Sacramento, CA 95817-2208 |
Second Address | Sacramento, CA 95817-2207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 24/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A53685 | (02) | CA |