Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 000000C30402 | CA |
NPI | 1003996190 |
---|---|
Provider Name | Roger L Crumley |
First Address | Los Angeles, CA 90051-3700 |
Second Address | Orange, CA 92868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 04/12/2007 |