Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | G47633 | CA |
NPI | 1033139043 |
---|---|
Provider Name | Dr. Lamont D Paxton |
First Address | San Leandro, CA 94578-2631 |
Second Address | San Leandro, CA 94578-2631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A50757 | (02) | CA |