Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G205980 | CA |
NPI | 1013935196 |
---|---|
Provider Name | Richard S Fightlin |
First Address | Porterville, CA 93257-3269 |
Second Address | Porterville, CA 93257-3269 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G702981 | (05) | CA |
A40968 | (02) |