Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G36832 | CA |
N | 207XS0106X | Orthopaedic Hand Surgeon | G36832 | CA |
N | 2086S0105X | Surgery of the Hand | G36832 | CA |
NPI | 1386635332 |
---|---|
Provider Name | Dr. Michael W Leathers |
First Address | Sacramento, CA 95816-5119 |
Second Address | Sacramento, CA 95816-5120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 16/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A46828 | (02) | CA |