Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | C51196 | CA |
NPI | 1083623193 |
---|---|
Provider Name | Dr. Luc Jasmin |
First Address | San Francisco, CA 94112-1737 |
Second Address | Redding, CA 96001-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 21/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6865 | (05) | OR |
7685441 | (05) | CA |
CA205563 | MEDICARE PTAN (01) | CA |
F74334 | (02) | CA |
F74334 | (02) | TX |
R167651 | MEDICARE PROVIDER TRANSACTION ACCESS NUMBER (01) | OR |