Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 1780 | TX |
N | 213ES0103X | Foot & Ankle Surgery | SC005677 | PA |
NPI | 1013959477 |
---|---|
Provider Name | Daren Michael Guertin |
First Address | Baytown, TX 77521-3900 |
Second Address | Baytown, TX 77521-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 05/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1780 | PODIATRY LICENSE (01) | TX |
SC005677 | PODIATRY LICENSE (01) | PA |
V10881 | (02) | TX |