Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC25520 | CA |
Y | 213ER0200X | Radiology | DC25520 | CA |
NPI | 1932138641 |
---|---|
Provider Name | Dr. Thomas Lawrence Taliaferro |
First Address | Ridgecrest, CA 93555-3150 |
Second Address | Ridgecrest, CA 93555-3150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 31/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1932138641 | NPI (01) | CA |
DC0255202 | BLUE SHIELD (01) | CA |
U75489 | (02) | CA |