Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A99605 | CA |
Y | 208600000X | Surgeon | A99605 | CA |
N | 2086X0206X | Surgical Oncologist | A99605 | CA |
NPI | 1215027396 |
---|---|
Provider Name | Dr. Simon Hovannes Telian |
First Address | Fort Bragg, NC 28310-0001 |
Second Address | Fort Bragg, NC 28310-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 29/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |