Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 1766 | AL |
NPI | 1326359704 |
---|---|
Provider Name | Dr. Daniel Rae York |
First Address | Moultrie, GA 31768-6784 |
Second Address | Moultrie, GA 31768-6784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003145277A | (05) | GA |
202I162911 | MEDICARE PTAN (01) | GA |