Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 061501 | GA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 061501 | GA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 240218 | NY |
NPI | 1053362822 |
---|---|
Provider Name | Daniel R Orcutt |
First Address | Atlanta, GA 30339-3035 |
Second Address | Stockbridge, GA 30281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 03/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10148871 | (05) | VA |
179602 | ANTHEM (01) | VA |
H84284 | (02) | |
P010240218 | EXCELLUS ROCHESTER (01) | NY |