Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | G 23616 | CA |
NPI | 1407831852 |
---|---|
Provider Name | Dr. Larry I Corman |
First Address | Vacaville, CA 95688-3526 |
Second Address | Sacramento, CA 95817-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 25/06/2008 |