Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G11921 | CA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | G11921 | CA |
NPI | 1255430146 |
---|---|
Provider Name | Dr. William C. Mentzer |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-2204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 24/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G119210 | (05) | CA |
F06407 | (02) | CA |