Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | G6310 | CA |
NPI | 1144328683 |
---|---|
Provider Name | Elwood Lenworth Kronick |
First Address | Walnut Creek, CA 94598-4863 |
Second Address | Walnut Creek, CA 94598-4863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A57496 | (02) | |
ZZZ73673Z | (05) | CA |