Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A124067 | CA |
NPI | 1013155092 |
---|---|
Provider Name | Dr. Dmitri Sofianos |
First Address | Savannah, GA 31405-3662 |
Second Address | Savannah, GA 31405-3662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013155092 | (05) | CA |
FS1707643 | DEA (01) | GA |