Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | G33000 | CA |
Y | 207RP1001X | Pulmonary Disease | G33000 | CA |
NPI | 1053344812 |
---|---|
Provider Name | Thomas Andrew Shragg |
First Address | Carmichael, CA 95608-2946 |
Second Address | Sacramento, CA 95825-5453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G330000 | (05) | CA |
A45378 | (02) | CA |