Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A124871 | CA |
NPI | 1295902492 |
---|---|
Provider Name | Dustin T Briggs |
First Address | Rancho Mirage, CA 92270-1058 |
Second Address | Palm Springs, CA 92262-0129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 04/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A124871 | STATE LICENSE (01) | CA |