Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | A47705 | CA |
NPI | 1114091816 |
---|---|
Provider Name | John Wesley Emison |
First Address | Los Gatos, CA 95032-2508 |
Second Address | Los Gatos, CA 95032-2508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 10/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
878 | ANESTHESIA (01) | CA |
BE1791753 | DEA (01) | CA |
D87080 | (02) |