Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | G64431 | CA |
NPI | 1104850668 |
---|---|
Provider Name | Julian F Keith III |
First Address | Redding, CA 96099-4032 |
Second Address | Redding, CA 96001-2509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G644310 | (05) | CA |
I15558 | (02) | CA |