Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G18945 | CA |
NPI | 1194719633 |
---|---|
Provider Name | Michael Lee Merrin |
First Address | Santa Barbara, CA 93150-0706 |
Second Address | Santa Barbara, CA 93101-2430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 07/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G189450 | (05) | CA |
A40467 | (02) |