Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | C53570 | CA |
NPI | 1043444854 |
---|---|
Provider Name | Jonathan Robert Drysdale |
First Address | Beverly Hills, CA 90213-3432 |
Second Address | Los Angeles, CA 90057-4002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2009 |
Last Update Date | 07/05/2009 |