Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | G56896 | CA |
NPI | 1093714925 |
---|---|
Provider Name | George A Perrine |
First Address | Long Beach, CA 90815 |
Second Address | Long Beach, CA 90815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 05/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G568960 | MEDI CAL (01) | CA |
C00701 | (02) | CA |