Individual
EVAN ROGERS RANSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 S ELISEO DR, SUITE 103, GREENBRAE, CA 94904-2133
(215) 469-0927
Mailing address
1000 S ELISEO DR, SUITE 103, GREENBRAE, CA 94904-2133
(215) 469-0927
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
MD437508
PA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
259357
NY
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
A117324
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A300045054
MEDICARE PTAN
—
01
—
FW557A
MEDICARE PTAN
CA
Enumeration date
12/28/2006
Last updated
10/15/2012
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