Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0900X | Dermatopathologist | A43801 | CA |
N | 207NS0135X | Procedural Dermatology | A43801 | CA |
NPI | 1326166521 |
---|---|
Provider Name | Dr. Lawrence Harry Matt |
First Address | Santa Monica, CA 90401-2857 |
Second Address | Santa Monica, CA 90401-2857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 26/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E32655 | (02) | CA |