Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | G27427 | CA |
NPI | 1013921360 |
---|---|
Provider Name | Dr. Thomas Norum |
First Address | La Quinta, CA 92253-4662 |
Second Address | La Quinta, CA 92253-4662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 05/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013921360 | (05) | CA |
A43350 | (02) | CA |