Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC14709 | CA |
NPI | 1578640702 |
---|---|
Provider Name | Steven L Olfert |
First Address | Reedley, CA 93654-2808 |
Second Address | Reedley, CA 93654-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 13/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T05475 | (02) | CA |