Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E-2493 | CA |
NPI | 1366655003 |
---|---|
Provider Name | Ronald Wayne Pinkard |
First Address | Oakland, CA 94606-2243 |
Second Address | Oakland, CA 94609-2509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E24930 | MEDI-CAL ID (01) | CA |
T11357 | (02) | CA |