Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | A119472 | CA |
NPI | 1043474596 |
---|---|
Provider Name | Igor Immerman |
First Address | San Francisco, CA 94158-2334 |
Second Address | San Francisco, CA 94158-2334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 03/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A119472 | MEDICAL LICENSE (01) | CA |
P01412212 | RAILROAD MEDICARE (01) | CA |