Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | E3976 | CA |
NPI | 1417941907 |
---|---|
Provider Name | James W Breedlove |
First Address | Morro Bay, CA 93442-2244 |
Second Address | Morro Bay, CA 93442-2244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 20/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E39760 | (05) | CA |
480021688 | RAILROAD MEDICARE (01) | CA |
U63222 | (02) | CA |