Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4584 | TN |
NPI | 1104994474 |
---|---|
Provider Name | Eric Scott Mcleod |
First Address | San Diego, CA 92129-3812 |
Second Address | San Diego, CA 92140-5692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2006 |
Last Update Date | 08/07/2007 |