Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G11067 | CA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | G11067 | CA |
NPI | 1528141421 |
---|---|
Provider Name | John R Sellman |
First Address | Santa Monica, CA 90404-2139 |
Second Address | Santa Monica, CA 90404-2139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A38205 | (02) | CA |