Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2505 | CA |
Y | 222Z00000X | Podiatrist | E2505 | CA |
NPI | 1033254255 |
---|---|
Provider Name | James Frederick Eggold |
First Address | Lakewood, CA 90712-2761 |
Second Address | Lakewood, CA 90712-2761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 01/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T19207 | (02) | CA |