Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A25357 | CA |
NPI | 1013940451 |
---|---|
Provider Name | Mr. Brian T Mc Caffrey |
First Address | Modesto, CA 95350-4429 |
Second Address | Modesto, CA 95350-4429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 29/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CD069A | MEDICARE GROUP PTAN (01) | CA |
CD233Y | MEDICARE INDIVIDUAL PTAN (01) | CA |
ZZZ48224Z | MEDICARE (01) | CA |