Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G25265 | CA |
N | 207ND0900X | Dermatopathologist | G25265 | CA |
N | 207NP0225X | Pediatric Dermatologist | G25265 | CA |
N | 207NS0135X | Procedural Dermatology | G25265 | CA |
NPI | 1003996828 |
---|---|
Provider Name | Michael Joseph Thoene |
First Address | El Cajon, CA 92020-6011 |
Second Address | El Cajon, CA 92020-6011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G252650 | (05) | CA |
A90932 | (02) | CA |
G25265 | STATE LICENSE NUMBER (01) | CA |