Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G38318 | CA |
NPI | 1003866518 |
---|---|
Provider Name | George A. Pugh |
First Address | Oakland, CA 94612-3725 |
Second Address | Oakland, CA 94612-3725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 17/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
244021500 | OWCP (01) | CA |
A47441 | (02) | CA |
GR0061080 | (05) | CA |