Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 016253 | CA |
NPI | 1760615868 |
---|---|
Provider Name | Dr. Steven Allen Barrack |
First Address | Palm Desert, CA 92260-3815 |
Second Address | Palm Desert, CA 92260-3815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2009 |
Last Update Date | 23/06/2014 |