Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A74349 | CA |
NPI | 1003830092 |
---|---|
Provider Name | Frederic Ransom Bushnell III |
First Address | Philadelphia, PA 19178-8113 |
Second Address | Pasadena, CA 91105-2625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 09/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A743490 | (05) | CA |
00A743490 | BLUE SHIELD (01) | CA |
00A743491 | BLUE SHIELD (01) | CA |
H91801 | (02) |