Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | C37001 | CA |
N | 207ND0900X | Dermatopathologist | C37001 | CA |
N | 207NS0135X | Procedural Dermatology | C37001 | CA |
NPI | 1003884925 |
---|---|
Provider Name | Gregory J Colman |
First Address | Santa Monica, CA 90404-2103 |
Second Address | Santa Monica, CA 90404-2103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 10/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W8759 | (02) | CA |