Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A-1900-15 | NM |
NPI | 1487847174 |
---|---|
Provider Name | Dr. Byron Drake Erstine |
First Address | Spanish Fork, UT 84660-1008 |
Second Address | Las Cruces, NM 88011-4701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2007 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
177624003 | (05) | AR |
200245010A | (05) | OK |
21423059 | (05) | NM |