Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | G152971 | CA |
NPI | 1053476887 |
---|---|
Provider Name | Robert L. Macdonald |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93720-1565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 07/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036085462 | (05) | IL |