Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 2000-01051 | NC |
Y | 207T00000X | Neurosurgeon | G77195 | CA |
NPI | 1043347248 |
---|---|
Provider Name | Michael J. Alexander |
First Address | Los Angeles, CA 90048-5901 |
Second Address | Los Angeles, CA 90048-5901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 05/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8912651 | (05) | NC |
G75042 | (02) |