Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G31289 | CA |
NPI | 1003864059 |
---|---|
Provider Name | Roger C Husted |
First Address | Monterey, CA 93940 |
Second Address | Monterey, CA 93940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/07/2007 |