Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC20071 | CA |
Y | 213ER0200X | Radiology | DC20071 | CA |
NPI | 1740358266 |
---|---|
Provider Name | Mr. Tracy Glenn Hoyt |
First Address | Murrieta, CA 92562-8955 |
Second Address | Murrieta, CA 92562-8955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
330876706 | TAX ID (01) | CA |
DC20071 | LICENSE NUMBER (01) | CA |