Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | MD17390 | OR |
NPI | 1952476350 |
---|---|
Provider Name | Dr. Daniel Mac Dowell Wayman |
First Address | Medford, OR 97504-8447 |
Second Address | Medford, OR 97504-8447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 29/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027792 | (05) | OR |
4004301-01 | BLUE CROSS (01) | OR |
931274301 | TAX ID (01) | OR |
BW1275305 | DEA (01) | OR |
E98979 | (02) | OR |
G62052 | MEDICAL LIC CALIF (01) | CA |
MD17390 | MEDICAL LIC OR (01) | OR |
XPY124720 | MEDICAL ID (01) | CA |