Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A30375 | CA |
N | 207PE0004X | Emergency Medical Services | A30375 | CA |
NPI | 1104933647 |
---|---|
Provider Name | Judd Karl Nicholas |
First Address | Monterey, CA 93942 |
Second Address | Monterey, CA 93940-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A303750 | BLUE SHIELD (01) | CA |
F05468 | (02) | CA |