Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A24275 | CA |
NPI | 1336217306 |
---|---|
Provider Name | Robert E Belknap |
First Address | Mill Valley, CA 94941-3034 |
Second Address | Mill Valley, CA 94941-3034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A242750 | (05) | CA |
A23891 | (02) | CA |