Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G029056 | CA |
Y | 208600000X | Surgeon | G029056 | CA |
NPI | 1013957950 |
---|---|
Provider Name | William Thomas Choctaw |
First Address | Covina, CA 91723 |
Second Address | Covina, CA 91723-1915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 15/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G290560 | (05) | CA |
A43944 | (02) | CA |