Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 087373 | NY |
NPI | 1013082973 |
---|---|
Provider Name | Dr. David Weaver Soule |
First Address | Penn Yan, NY 14527-9420 |
Second Address | Rochester, NY 14620-1662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
087373 | LICENSE NUMBER (01) | NY |
AS0517193 | DEA NUMBER (01) | NY |