Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | G44506 | CA |
NPI | 1023076692 |
---|---|
Provider Name | Dr. Thomas B Hargrave III |
First Address | Oakland, CA 94612 |
Second Address | Oakland, CA 94612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 06/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A49670 | (02) |