Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | G32011 | CA |
NPI | 1841442290 |
---|---|
Provider Name | Dr. William S Eidelman |
First Address | Los Angeles, CA 90028-6202 |
Second Address | Los Angeles, CA 90028-6202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2008 |
Last Update Date | 16/10/2008 |