Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A96461 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A96461 | CA |
NPI | 1811094873 |
---|---|
Provider Name | Marc David Chodos |
First Address | La Mesa, CA 91942-3020 |
Second Address | La Mesa, CA 91942-3020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 16/09/2010 |