Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 25873 | CA |
Y | 213EG0000X | General Practice | 25873 | CA |
NPI | 1003908096 |
---|---|
Provider Name | Dr. Scott Perrine Churchill |
First Address | Fair Oaks, CA 95628-1706 |
Second Address | Rancho Cordova, CA 95670-4265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 11/12/2009 |