Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | E 2875 | AR |
NPI | 1073513040 |
---|---|
Provider Name | Dr. Diwakar T Pulisetty |
First Address | Weldon, AR 72112-9461 |
Second Address | Newport, AR 72112-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H35955 | (02) | AR |