Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A31200 | CA |
NPI | 1215941141 |
---|---|
Provider Name | Dr. Peter Vokes Madill |
First Address | Sebastopol, CA 95472-4569 |
Second Address | Sebastopol, CA 95472-4569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 21/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A26387 | (02) | CA |