Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G55722 | CA |
NPI | 1245276187 |
---|---|
Provider Name | Gary A Pattee |
First Address | Thousand Oaks, CA 91361-1023 |
Second Address | Thousand Oaks, CA 91361-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 06/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A53022 | (02) | CA |
AP1964279 | DEA NUMBER (01) | CA |