Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G60256 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G60256 | CA |
NPI | 1053365007 |
---|---|
Provider Name | John David Tomasin |
First Address | Santa Rosa, CA 95403-3634 |
Second Address | Healdsburg, CA 95448-3384 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 08/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G602560 | (05) | CA |
A53575 | (02) |