Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 17683 | CA |
NPI | 1205949146 |
---|---|
Provider Name | Dr. Simon Gamer |
First Address | Beverly Hills, CA 90210 |
Second Address | Beverly Hills, CA 90210-4321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 04/12/2014 |