Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | G6096 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | G6096 | TX |
NPI | 1225073216 |
---|---|
Provider Name | Dr. Denton Watumull |
First Address | Richardson, TX 75082-3566 |
Second Address | Richardson, TX 75082-3566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 11/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E82741 | (02) | |
PO88X1212 | (05) | TX |