Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 703 | TN |
N | 222Z00000X | Podiatrist | 703 | TN |
Y | 213ES0103X | Foot & Ankle Surgery | 703 | TN |
N | 213ES0103X | Foot & Ankle Surgery | SC005923 | PA |
NPI | 1043472269 |
---|---|
Provider Name | Dr. Sebastien Gabriel Demoiny |
First Address | Morristown, TN 37813-2283 |
Second Address | Morristown, TN 37813-2283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2008 |
Last Update Date | 14/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1520364 | (05) | TN |
DPM703 | STATE LICENSE (01) | TN |
SC005923 | STATE LICENSE (01) | PA |