Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | A72448 | CA |
NPI | 1356345789 |
---|---|
Provider Name | Peter S Uzelac |
First Address | Greenbrae, CA 94904-2017 |
Second Address | Greenbrae, CA 94904-2017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 05/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000480316 | ANTHEM PSC (01) | KY |
200878600 | (05) | IN |
50011330 | PASSPORT SPECIALITY PSC (01) | KY |
50011331 | PASSPORT SPECIALITY- FOUNDATION (01) | KY |
50011332 | PASSPORT PCP FOUNDATION (01) | KY |
64120736 | (05) | KY |
H55541 | (02) | CA |