Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G35151 | CA |
NPI | 1023118205 |
---|---|
Provider Name | Mr. Alan Wm Heller |
First Address | Long Beach, CA 90804 |
Second Address | Long Beach, CA 90804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 01/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A46232 | (02) |