Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 01032803 | IN |
NPI | 1033138417 |
---|---|
Provider Name | David Andrew Hormuth |
First Address | Belfast, ME 04915-4021 |
Second Address | Evansville, IN 47714-0521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 19/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100327090 | (05) | IN |