Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G59198 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G59198 | CA |
NPI | 1417958273 |
---|---|
Provider Name | Dr. Morgan Lawrence Magid |
First Address | Santa Cruz, CA 95065-1709 |
Second Address | Santa Cruz, CA 95065-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 19/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F09922 | (02) | CA |