Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 35545 | MA |
NPI | 1649319682 |
---|---|
Provider Name | Dr. John Day Deweese |
First Address | Springfield, MA 01104-2330 |
Second Address | Springfield, MA 01104-2330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A68263 | (02) | MA |