Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1982882155 |
---|---|
Provider Name | Paul M Easterwood |
First Address | Oakland, CA 94609-1310 |
Second Address | Oakland, CA 94609-1310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2008 |
Last Update Date | 13/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C26329 | BOC (01) |