Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 075586 | GA |
N | 207N00000X | Dermatologist | G85512 | CA |
NPI | 1023196938 |
---|---|
Provider Name | Moses Elam |
First Address | Oakland, CA 94612-3429 |
Second Address | Stockton, CA 95210-3377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 27/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G855120 | (05) | CA |
B78336 | (02) |