Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G69035 | CA |
N | 208600000X | Surgeon | G69035 | CA |
Y | 2086X0206X | Surgical Oncologist | G69035 | CA |
NPI | 1033177803 |
---|---|
Provider Name | Dr. Michael Bouvet |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 17/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G690350 | (05) | CA |
G11608 | (02) |