Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G13225 | CA |
N | 2080P0202X | Pediatric Cardiologist | G13225 | CA |
NPI | 1285730093 |
---|---|
Provider Name | Dr. Paul Stanger |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 22/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G132250 | (05) | CA |
A38911 | (02) | CA |