Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | E3506 | CA |
NPI | 1508333758 |
---|---|
Provider Name | Lc Loggins |
First Address | Oakland, CA 94605-2603 |
Second Address | Oakland, CA 94605-2603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 25/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E35061 | (05) | CA |