Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 20A8247CA | CA |
NPI | 1881722247 |
---|---|
Provider Name | Dr. Thomas Reece |
First Address | San Rafael, CA 94903-2007 |
Second Address | San Rafael, CA 94903-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A8247CA | LICENSE (01) | CA |