Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 38812 | CA |
Y | 213EG0000X | General Practice | 38812 | CA |
NPI | 1003823642 |
---|---|
Provider Name | Dr. Richard Terrell Canada |
First Address | Visalia, CA 93277 |
Second Address | Visalia, CA 93277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164742 | CGP (01) | |
B3881201 | DENTICAL (01) | CA |