Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 0101046457 | VA |
NPI | 1013919398 |
---|---|
Provider Name | Dr. Timothy Wayne Brotherton |
First Address | Danville, VA 24541-4155 |
Second Address | Danville, VA 24541-4155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 19/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6060641 | (05) | VA |
A03010 | (02) | VA |