Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G83236 | CA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | G83236 | CA |
NPI | 1184693376 |
---|---|
Provider Name | Dr. Leonard Joseph Brazil |
First Address | Chico, CA 95928-8347 |
Second Address | Chico, CA 95928-8347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G832360 | (05) | CA |
G41819 | (02) | |
ZZZ52846Z | BLUE SHIELD (01) |