Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G11837 | CA |
NPI | 1013942648 |
---|---|
Provider Name | Joel Alan Teisch |
First Address | San Francisco, CA 94120-7464 |
Second Address | San Francisco, CA 94110-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G118370 | (05) | CA |
F9871 | (02) |