Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E4147 | CA |
NPI | 1023112554 |
---|---|
Provider Name | Dr. Thomas John Elardo |
First Address | San Jose, CA 95124-4109 |
Second Address | San Jose, CA 95124-4109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U71341 | (02) | CA |