Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G35018 | CA |
NPI | 1023030582 |
---|---|
Provider Name | Peter Webb |
First Address | Mountain View, CA 94040-4211 |
Second Address | San Mateo, CA 94401-2778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 29/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
942881809 | PROVIDER ID (01) | CA |
A46184 | (02) | CA |