Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A23299 | CA |
NPI | 1811099179 |
---|---|
Provider Name | T Tom Ackerson II |
First Address | Pasadena, CA 91105-3045 |
Second Address | Pasadena, CA 91105-3023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A23468 | (02) | CA |