Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | J2420 | TX |
NPI | 1023083482 |
---|---|
Provider Name | Dr. Daniel D. Witheiler |
First Address | Dallas, TX 75203-1264 |
Second Address | Dallas, TX 75203-1264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 24/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G35272 | (02) | TX |