Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 33799 | DC |
N | 2086S0129X | Vascular Surgeon | 51943 | SC |
NPI | 1023000858 |
---|---|
Provider Name | David Deaton |
First Address | Boston, MA 02241-8283 |
Second Address | Columbia, SC 29203-6839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 06/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
519433 | (05) | SC |
F43465 | (02) |