Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | G29165 | CA |
NPI | 1023109956 |
---|---|
Provider Name | Dr. Walter Miles Fierson |
First Address | Arcadia, CA 91007 |
Second Address | Arcadia, CA 91007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 20/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A43969 | (02) |