Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A24331 | CA |
NPI | 1568583201 |
---|---|
Provider Name | Gerald Dennis Main |
First Address | Cambria, CA 93428-1462 |
Second Address | Cambria, CA 93428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |