Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A108303 | CA |
NPI | 1053585711 |
---|---|
Provider Name | Lyman William Whitlatch JR. |
First Address | Fresno, CA 93721-1431 |
Second Address | Visalia, CA 93291-6238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2008 |
Last Update Date | 05/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1841218583 | (05) | CA |