Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 24024 | SC |
NPI | 1124029103 |
---|---|
Provider Name | Dr. Paul Douglas Deholl |
First Address | Belfast, ME 04915-4473 |
Second Address | Columbia, SC 29203-6882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 21/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G82498 | (02) | SC |
T79821 | (05) | SC |