Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 20958 | CA |
NPI | 1013020601 |
---|---|
Provider Name | Dr. Robert M Walley |
First Address | San Francisco, CA 94102-1303 |
Second Address | San Francisco, CA 94102-1303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |