Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 27286 | SC |
NPI | 1902938053 |
---|---|
Provider Name | Christopher Robert Hydorn |
First Address | Belfast, ME 04915-4473 |
Second Address | Columbia, SC 29203-6877 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 09/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
272868 | (05) | SC |