Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 49312 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A94751 | CA |
NPI | 1255482527 |
---|---|
Provider Name | Robert Ferdowsmakan |
First Address | San Diego, CA 92130-6657 |
Second Address | San Diego, CA 92130-6657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 08/07/2007 |