Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A95031 | CA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A95031 | CA |
NPI | 1578640918 |
---|---|
Provider Name | Dr. Matthew B Zavod |
First Address | Woodland, CA 95695-5131 |
Second Address | Woodland, CA 95695-5131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 03/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A950310 | (05) | CA |
00A950310 | BLUE SHIELD (01) | CA |
P00745239 | MEDICARE RAILROAD CARRIER (01) | CA |