Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G59930 | CA |
NPI | 1013932052 |
---|---|
Provider Name | Gregory Scott Macdonell |
First Address | Los Gatos, CA 95032 |
Second Address | Los Gatos, CA 95032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 05/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G599300 | (05) | CA |
A90026 | (02) |