Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 48350 | WI |
NPI | 1265451058 |
---|---|
Provider Name | Jonathan Edward Tammela |
First Address | Santa Maria, CA 93454-4890 |
Second Address | Santa Maria, CA 93454-5915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 14/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34678500 | (05) | WI |
I40627 | (02) |