Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | DO173551 | OR |
NPI | 1083920177 |
---|---|
Provider Name | Dr. David Michael Souza |
First Address | Klamath Falls, OR 97601-1106 |
Second Address | Klamath Falls, OR 97601-1106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2010 |
Last Update Date | 17/09/2015 |