Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G50408 | CA |
N | 207ND0900X | Dermatopathologist | 00G504080 | CA |
NPI | 1255331161 |
---|---|
Provider Name | Paul D Hartman |
First Address | Daly City, CA 94015-2228 |
Second Address | Daly City, CA 94015-2228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 22/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A51670 | (02) |