Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | G28436 | CA |
Y | 207RH0003X | Hematology & Oncology | G28436 | CA |
N | 207RX0202X | Medical Oncology | G28436 | CA |
NPI | 1417047283 |
---|---|
Provider Name | Leroy Wayne Keiser |
First Address | Santa Rosa, CA 95403-1757 |
Second Address | Santa Rosa, CA 95403-1757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 03/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G284360 | (05) | CA |
A89466 | (02) |