Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | G36115 | CA |
NPI | 1093747396 |
---|---|
Provider Name | Thomas Schram Enloe |
First Address | Hanford, CA 93230-3500 |
Second Address | Hanford, CA 93230-3785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 15/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G361150 | (05) | CA |
A46581 | (02) | CA |
G361150 | STATE LICENSE (01) | CA |