Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | D0084939 | MD |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D0084939 | MD |
NPI | 1134415706 |
---|---|
Provider Name | Dr. Kenneth William Defontes III |
First Address | Towson, MD 21204-2065 |
Second Address | Towson, MD 21204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 01/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D0084939 | MARYLAND LICENSE (01) | MD |