Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN 20469 | FL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A137085 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | ME 114524 | FL |
NPI | 1255416459 |
---|---|
Provider Name | Dr. Stone Rangarajan Thayer |
First Address | San Diego, CA 92123-4288 |
Second Address | San Diego, CA 92123-4288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 02/07/2015 |