Doctor Name: | DR. TAKMAN ERIC MACK |
NPI Number: | 1114082609 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 01064080A |
Business Practice Address: | 34800 Bob Wilson Dr Naval Medical Center San Diego San Diego, CA - 921341098 |
Business Phone Number: | 6195328666 |
Business Fax Number: | |
Mailing Address: | 34800 Bob Wilson Dr, Naval Medical Center San Diego SAN DIEGO |
State: | CA |
Postal Code: | 921341098 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/26/2006 |
NPI Last Update Date: | 02/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01064080A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |