Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | C50285 | CA |
N | 222Z00000X | Podiatrist | C50285 | CA |
Y | 224P00000X | Prosthetist | CP004038 | DE |
NPI | 1174968630 |
---|---|
Provider Name | Logan Newton |
First Address | Bakersfield, CA 93301-1816 |
Second Address | Bakersfield, CA 93301-1816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2013 |
Last Update Date | 05/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C50285 | BOC (01) | CA |
CP004038 | ABC (01) |