Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | G29964 | CA |
NPI | 1487647244 |
---|---|
Provider Name | Dr. Robert Wesman |
First Address | Oakland, CA 94609-1810 |
Second Address | Oakland, CA 94609-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 24/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G299460 | (05) | CA |