Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | DO041780 | MI |
NPI | 1164428298 |
---|---|
Provider Name | Dr. David L Oviatt |
First Address | Grand Rapids, MI 49546-2109 |
Second Address | Grand Rapids, MI 49525-7007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B45795 | (02) |