Brummitte Dale Wilson
Procedural Dermatology MOHS-Micrographic Surgeon
17 Long Ave Suite 200
Hamburg
, New York 14075-6200
Brummitte Dale Wilson
Procedural Dermatology MOHS-Micrographic Surgeon
17 Long Ave Suite 200
Hamburg
, New York 14075-6200
(716) 646-4642
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About
Features
Specialties
- MOHS-Micrographic Surgeon
- Procedural Dermatology
Languages spoken
- English
Location
First Address
- Brummitte Dale Wilson
- 17 Long Ave Suite 200
- Hamburg, NY
- Zip : 14075-6200
- Fax : (716) 646-4642
- Phone : (716) 648-2770
Second Address
- Brummitte Dale Wilson
- 17 Long Ave Suite 200
- Hamburg, NY
- Zip : 14075-6200
- Fax : (716) 646-4642
- Phone : (716) 648-2770
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207ND0101X | MOHS-Micrographic Surgeon | 134469 | NY |
| N | 207NS0135X | Procedural Dermatology | 1344691 | NY |
National Provider Identifier
| NPI | 1245237288 |
|---|---|
| Provider Name | Brummitte Dale Wilson |
| First Address | Hamburg, NY 14075-6200 |
| Second Address | Hamburg, NY 14075-6200 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/07/2005 |
| Last Update Date | 21/08/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| B71670 | (02) | NY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.