Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD183533 | OR |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD183533 | OR |
NPI | 1386934388 |
---|---|
Provider Name | Daniel James Bouton |
First Address | Philadelphia, PA 19178-7642 |
Second Address | Portland, OR 97239-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2011 |
Last Update Date | 15/02/2021 |