Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 034583 | NY |
NPI | 1578554119 |
---|---|
Provider Name | Dr. Erhard Alfred Beuttenmuller |
First Address | Fort Drum, NY 13602-5005 |
Second Address | Fort Drum, NY 13602-5005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) | NY |