Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G46675 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G46675 | CA |
NPI | 1235282856 |
---|---|
Provider Name | Dr. Michael Mccray |
First Address | Valencia, CA 91355-5636 |
Second Address | Valencia, CA 91355-5636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 13/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W17939 | (02) | CA |