Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E2178 | CA |
NPI | 1003013566 |
---|---|
Provider Name | Marc Alan Benard |
First Address | Torrance, CA 90505-2413 |
Second Address | Torrance, CA 90505-2413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11215 | (02) |