Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 10391490-1205 | UT |
Y | 207X00000X | Orthopaedic Surgeon | 12630A | WY |
N | 207X00000X | Orthopaedic Surgeon | FE167365 | OR |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | FE167365 | OR |
NPI | 1104230374 |
---|---|
Provider Name | Ari David Amitai |
First Address | Casper, WY 82609-3265 |
Second Address | Casper, WY 82609-3265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2014 |
Last Update Date | 03/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FE167365 | LICENSE (01) | OR |