Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | T2003013836 | MO |
NPI | 1083718266 |
---|---|
Provider Name | Derek Kern Hewitt |
First Address | Columbia, MO 65202 |
Second Address | Prescott, AZ 86305-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 14/08/2012 |