Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | A84990 | CA |
N | 208200000X | Surgeon | A84990 | CA |
N | 208600000X | Surgeon | A84990 | CA |
NPI | 1639141690 |
---|---|
Provider Name | Dr. Randolph L. Schaffer III |
First Address | San Diego, CA 92127-5705 |
Second Address | La Jolla, CA 92037-1027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 25/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A849900 | (05) | CA |