Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 228170 | NY |
N | 111NI0900X | Internist | 228170 | NY |
N | 2080P0203X | Pediatric Critical Care Doctor | 228170 | NY |
Y | 2080P0203X | Pediatric Critical Care Doctor | C152808 | CA |
NPI | 1184681603 |
---|---|
Provider Name | Maude E Dull |
First Address | San Francisco, CA 94118-1981 |
Second Address | San Francisco, CA 94158-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 28/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00028182101 | UNIVERA (01) | |
000529327003 | BC/BS (01) | |
02889949 | (05) | NY |
071221000006 | FIDELIS (01) | |
1020856180001 | (05) | PA |
1214337 | IHA (01) |