Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | G13523 | CA |
NPI | 1063564425 |
---|---|
Provider Name | Lynn Cranmer |
First Address | Pasadena, CA 91188-0001 |
Second Address | Bakersfield, CA 93301-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G135230 | (05) | CA |
A39006 | (02) |