Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A71530 | CA |
NPI | 1205942653 |
---|---|
Provider Name | Timothy Robert Mcadams |
First Address | Palo Alto, CA 94304-1811 |
Second Address | Palo Alto, CA 94304-1811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H43414 | (02) | CA |