Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 161338 | NY |
NPI | 1033105309 |
---|---|
Provider Name | Braxton L Hillerman |
First Address | Watertown, NY 13601-4063 |
Second Address | Watertown, NY 13601-4063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00878313 | (05) | NY |
B81179 | (02) |