Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A64483 | CA |
NPI | 1003920497 |
---|---|
Provider Name | Dr. Ridgely Oliver Muller |
First Address | Santa Rosa, CA 95405-4801 |
Second Address | Santa Rosa, CA 95405-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 09/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A644830 | (05) | CA |
H27742 | (02) | CA |