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Individual
Inactive
Individual
Inactive
Sole proprietor
Provider details
NPI number
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A26739
CA
208800000X
Urology Physician
A26739
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A267390
—
CA
01
—
340001130
RAILROAD MEDICARE
CA
Enumeration date
—
Last updated
—
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