Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 042-0013275 | VT |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 042.0013275 | VT |
NPI | 1205077591 |
---|---|
Provider Name | Dr. Derek Chase |
First Address | Winooski, VT 05404-2182 |
Second Address | Saint Albans, VT 05478-9753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2009 |
Last Update Date | 10/01/2017 |