Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 267126 | MA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A171785 | CA |
NPI | 1225485832 |
---|---|
Provider Name | Andrew Okon Usoro |
First Address | Boston, MA 02114 |
Second Address | Los Angeles, CA 90045-9212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2016 |
Last Update Date | 06/08/2021 |