Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | G27251 | CA |
NPI | 1447321351 |
---|---|
Provider Name | Gary A. Jaeger |
First Address | Pasadena, CA 91188-0001 |
Second Address | Harbor City, CA 90710-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G272510 | (05) | CA |
A43290 | (02) |