Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | A25739 | CA |
NPI | 1083647226 |
---|---|
Provider Name | Dr. Laurence Wilbur Hartley |
First Address | Ukiah, CA 95482-8325 |
Second Address | Ukiah, CA 95482-8325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A257391 | (05) | CA |
A24555 | (02) | CA |