Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A70766 | CA |
NPI | 1144341918 |
---|---|
Provider Name | Marc Lawrence Dyer |
First Address | San Clemente, CA 92673-7116 |
Second Address | Laguna Niguel, CA 92677-2083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H85297 | (02) | CA |