Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 19300 | CA |
NPI | 1912124868 |
---|---|
Provider Name | Dr. Lee W Schaller |
First Address | Sonoma, CA 95476-6827 |
Second Address | Sonoma, CA 95476-6827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 26/04/2013 |