Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A75232 | CA |
NPI | 1003858697 |
---|---|
Provider Name | Kurt Dieter Dittmar |
First Address | San Francisco, CA 94120-7793 |
Second Address | Walnut Creek, CA 94598-3122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A752320 | (05) | CA |
H82918 | (02) |