Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | G67121 | CA |
NPI | 1114034477 |
---|---|
Provider Name | Dr. Randolph Craig O'hara |
First Address | Torrance, CA 90505-5233 |
Second Address | Torrance, CA 90505-5233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F85215 | (02) | CA |
ZZZ02606Z | BLUE SHIELD ZZ NUMBER (01) | CA |