Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G20792 | CA |
NPI | 1073553954 |
---|---|
Provider Name | Joe F Neal |
First Address | Modesto, CA 95357-6649 |
Second Address | Modesto, CA 95350-4405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 21/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A41075 | (02) | |
ZZZ76734Z | (05) | CA |