Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E1228 | CA |
Y | 222Z00000X | Podiatrist | E1228 | CA |
NPI | 1003980749 |
---|---|
Provider Name | Noel Stephen Obrien |
First Address | San Francisco, CA 94118-1625 |
Second Address | San Francisco, CA 94118-1625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T10841 | (02) |