Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G70877 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G70877 | CA |
NPI | 1356428148 |
---|---|
Provider Name | Dr. Michael P. Muldoon |
First Address | San Diego, CA 92111-3738 |
Second Address | San Diego, CA 92111-3738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 04/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G708770 | (05) | CA |
G07544 | (02) | CA |