Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | G18764 | CA |
NPI | 1396883286 |
---|---|
Provider Name | Dr. Richard W Sagebiel |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G187640 | (05) | CA |
A40414 | (02) | CA |