Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E3812 | CA |
Y | 222Z00000X | Podiatrist | E3812 | CA |
NPI | 1023097318 |
---|---|
Provider Name | Steven G Bissot |
First Address | Redding, CA 96003 |
Second Address | Redding, CA 96003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E38120 | (05) | CA |
U18456 | (02) |