Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 20A12596 | CA |
N | 207XS0106X | Orthopaedic Hand Surgeon | 20A12596 | CA |
N | 207XS0106X | Orthopaedic Hand Surgeon | 5505 | OH |
NPI | 1033111026 |
---|---|
Provider Name | Marc A Trzeciak |
First Address | Modesto, CA 95350-5512 |
Second Address | Modesto, CA 95350-5512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 19/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0188461 | (05) | OH |
200168390 | RAILROAD MEDICARE (01) | OH |
G10950 | (02) | OH |