Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | M8207 | ID |
NPI | 1164465977 |
---|---|
Provider Name | Dr. David Bernard Verst |
First Address | Hailey, ID 83333 |
Second Address | Hailey, ID 83333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 16/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
806197100 | (05) | ID |
H24785 | (02) | ID |