Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA56685 | NJ |
Y | 207U00000X | Nuclear Medicine Specialist | G89012 | CA |
N | 207U00000X | Nuclear Medicine Specialist | MD00046429 | WA |
N | 208D00000X | General Practice Physician | 25MA56685 | NJ |
NPI | 1356332373 |
---|---|
Provider Name | Jon Thomas Umlauf |
First Address | San Diego, CA 92120-2507 |
Second Address | San Diego, CA 92120-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |