Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 119 | WY |
NPI | 1295868727 |
---|---|
Provider Name | David A Duckwitz |
First Address | Rock Springs, WY 82901-4771 |
Second Address | Rock Springs, WY 82901-4771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116937800 | (05) | WY |
U86019 | (02) | WY |