Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | G42752 | CA |
NPI | 1508886235 |
---|---|
Provider Name | Dr. Shields Brewster Abernathy |
First Address | Templeton, CA 93465-9729 |
Second Address | Templeton, CA 93465-9729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G427520 | (05) | CA |
77-0049521 | FEIN NUMBER (01) | |
A89763 | (02) | CA |