Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC24135 | CA |
Y | 213ER0200X | Radiology | DC24135 | CA |
NPI | 1851325740 |
---|---|
Provider Name | Mark Oliver Gour |
First Address | Paso Robles, CA 93447-2479 |
Second Address | Bakersfield, CA 93308-5034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |