Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G16447 | CA |
Y | 208600000X | Surgeon | G16447 | CA |
NPI | 1013087915 |
---|---|
Provider Name | Richard Nagle |
First Address | Martinez, CA 94553-4098 |
Second Address | Martinez, CA 94553-3156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |