Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G83671 | CA |
NPI | 1215039284 |
---|---|
Provider Name | Marc Arnold Samson |
First Address | Los Angeles, CA 90017 |
Second Address | Los Angeles, CA 90017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G69177 | (02) | CA |