Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | G39324 | CA |
N | 208200000X | Surgeon | G39324 | CA |
N | 208600000X | Surgeon | G39324 | CA |
N | 2082S0105X | Plastic Hand Surgeon | G39324 | CA |
N | 208200000X | Surgeon | G39324 | CA |
N | 208600000X | Surgeon | G39324 | CA |
N | 2086S0105X | Surgery of the Hand | G39324 | CA |
N | 2086S0120X | Pediatric Surgery | G39324 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | G39324 | CA |
N | 2086S0127X | Trauma Surgeon | G39324 | CA |
NPI | 1215966809 |
---|---|
Provider Name | Dr. Pearlman David Hicks JR. |
First Address | Long Beach, CA 90806-3260 |
Second Address | Long Beach, CA 90806-3260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 28/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G39324 | PHYSICIAN LINCES NUMBER (01) | CA |