Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A23550 | CA |
N | 208600000X | Surgeon | A23550 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A23550 | CA |
NPI | 1003845090 |
---|---|
Provider Name | Michael Nathanson |
First Address | San Jose, CA 95128-2604 |
Second Address | San Jose, CA 95128-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 12/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A235500 | (05) | CA |
B25094 | (02) | CA |