Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 45296 | CA |
NPI | 1033256789 |
---|---|
Provider Name | Dr. Robert Wayne Mower |
First Address | Valencia, CA 91355 |
Second Address | Valencia, CA 91355-4488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 09/04/2015 |