Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A52915 | CA |
N | 207YP0228X | Pediatric Otolaryngology | A52915 | CA |
N | 207YS0123X | Facial Plastic Surgeon | A52915 | CA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | A52915 | CA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A52915 | CA |
NPI | 1831260884 |
---|---|
Provider Name | Edgar A. Lueg |
First Address | Ventura, CA 93003-2773 |
Second Address | Ventura, CA 93003-2773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 19/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A529150 | MEDICAL (01) | CA |
G61768 | (02) | CA |