Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | C38023 | CA |
NPI | 1144261173 |
---|---|
Provider Name | John B Overton |
First Address | Stockton, CA 95203-2441 |
Second Address | Stockton, CA 95203-2441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 15/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A36822 | (02) | |
OOC380230 | (05) | CA |