Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | C29097 | CA |
NPI | 1649381252 |
---|---|
Provider Name | George William Lefevre |
First Address | San Diego, CA 92109-8201 |
Second Address | San Diego, CA 92109-8201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 05/11/2021 |