Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G30894 | CA |
Y | 2080P0201X | Pediatric Allergist | G30894 | CA |
NPI | 1053354456 |
---|---|
Provider Name | Dr. Morton J. Cowan |
First Address | San Francisco, CA 94143-1278 |
Second Address | San Francisco, CA 94143-2204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 16/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G308940 | (05) | CA |
E60183 | (02) | CA |