Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G65619 | CA |
NPI | 1053408542 |
---|---|
Provider Name | Patrick Fann |
First Address | Mountain View, CA 94040-6201 |
Second Address | Mountain View, CA 94040-2833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 30/11/2011 |