Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | G61537 | CA |
NPI | 1336100379 |
---|---|
Provider Name | Thomas T Haider |
First Address | Riverside, CA 92506-3440 |
Second Address | Riverside, CA 92507-0754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G615370 | (05) | CA |
D25079 | (02) | CA |
GR0086790 | (05) | CA |