Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207NS0135X | Procedural Dermatology | G63334 | CA |
NPI | 1467421917 |
---|---|
Provider Name | William P Mansfield |
First Address | San Diego, CA 92101-7276 |
Second Address | San Diego, CA 92101-7276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 18/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000196899 | ANTHEM BCBS (01) | OH |
2244217 | (05) | OH |
300121591 | RAILROAD MEDICARE (01) | OH |
E83340 | (02) | |
E83340 | (02) | CA |