Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2303 | CA |
Y | 222Z00000X | Podiatrist | E2303 | CA |
NPI | 1053354340 |
---|---|
Provider Name | Dr. Thomas O Hyland |
First Address | Capitola, CA 95010-2759 |
Second Address | Capitola, CA 95010-2759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 14/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11271 | (02) |