Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A79397 | CA |
NPI | 1003994765 |
---|---|
Provider Name | Montague G. Carr |
First Address | Oakland, CA 94612-3466 |
Second Address | Sacramento, CA 95825-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A793970 | (05) | CA |
H74974 | (02) |