Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | G23457 | CA |
NPI | 1376621177 |
---|---|
Provider Name | Thomas L. Ewing |
First Address | Oakland, CA 94612-3429 |
Second Address | Oakland, CA 94611-5642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 07/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G234570 | (05) | CA |
F16544 | (02) |