Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 9639 | NV |
Y | 207RR0500X | Rheumatology | C54037 | CA |
NPI | 1104891290 |
---|---|
Provider Name | Gregory David Middleton |
First Address | La Jolla, CA 92037-1300 |
Second Address | La Jolla, CA 92037-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 28/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2018674 | (05) | NV |
F83986 | (02) |