Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 9503 | NV |
Y | 222Z00000X | Podiatrist | 9503 | NV |
N | 213E00000X | Podiatrist | E3878 | CA |
N | 222Z00000X | Podiatrist | E3878 | CA |
NPI | 1003979931 |
---|---|
Provider Name | Andrew Hewchuck |
First Address | Bishop, CA 93514-3413 |
Second Address | Bishop, CA 93514-3413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 07/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E38780 | (05) | CA |
0738750001 | DMERC MEDICARE (01) | CA |
480014561 | RAILROAD MEDICARE (01) | CA |
U42983 | (02) | CA |