Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CO001238 | CA |
Y | 222Z00000X | Podiatrist | CO001238 | CA |
N | 225000000X | Orthotic Fitter |
NPI | 1710283858 |
---|---|
Provider Name | Robert Patterson |
First Address | San Jose, CA 95128-1478 |
Second Address | San Jose, CA 95128-1478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2011 |
Last Update Date | 14/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XA0012380 | (05) | CA |