Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G75756 | CA |
NPI | 1003994757 |
---|---|
Provider Name | Richard S. Isaacs |
First Address | Oakland, CA 94612-3466 |
Second Address | Sacramento, CA 95823-4671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G757560 | (05) | CA |
F67327 | (02) |