Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E4048 | CA |
NPI | 1033137427 |
---|---|
Provider Name | Michael Darin Mcgavic |
First Address | Norwalk, CA 90650-2559 |
Second Address | Norwalk, CA 90650-2559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 28/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E40480 | (05) | CA |
U66327 | (02) | CA |