Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0290 | NH |
N | 213ES0103X | Foot & Ankle Surgery | 0290 | NH |
NPI | 1225089022 |
---|---|
Provider Name | Dr. Thomas H Detwiller |
First Address | Concord, NH 03301-2588 |
Second Address | Concord, NH 03301-2588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 20/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30360588 | (05) | NH |
U72695 | (02) | NH |