Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G33292 | CA |
NPI | 1013949049 |
---|---|
Provider Name | Dr. Robert Daniel Teasdale JR. |
First Address | Greenbrae, CA 94904-2013 |
Second Address | Greenbrae, CA 94904-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 20/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A45494 | (02) | CA |