Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 20A17398 | CA |
NPI | 1699014464 |
---|---|
Provider Name | Deric H Nye |
First Address | Madera, CA 93636-8762 |
Second Address | Madera, CA 93636-8762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2013 |
Last Update Date | 13/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1699014464 | (05) | CA |