Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD437508 | PA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 259357 | NY |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A117324 | CA |
NPI | 1134285091 |
---|---|
Provider Name | Evan Rogers Ransom |
First Address | Greenbrae, CA 94904-2133 |
Second Address | Greenbrae, CA 94904-2133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 15/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A300045054 | MEDICARE PTAN (01) | |
FW557A | MEDICARE PTAN (01) | CA |