Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | A112118 | CA |
Y | 207YS0123X | Facial Plastic Surgeon | A112118 | CA |
NPI | 1457573503 |
---|---|
Provider Name | Patrick Chase Lay |
First Address | San Jose, CA 95124-4104 |
Second Address | San Jose, CA 95124-4104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 26/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A112118 | CALIFORNIA MEDICAL LICENSE (01) | CA |