Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A25679 | CA |
NPI | 1578509048 |
---|---|
Provider Name | Michael L Goris |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 04/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A256790 | (05) | CA |
300107006 | RAILROAD MEDICARE (01) | CA |