Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E1-0000198 | DE |
N | 213ES0103X | Foot & Ankle Surgery | P00550 | MD |
N | 213ES0103X | Foot & Ankle Surgery | SC006011 | PA |
NPI | 1083811541 |
---|---|
Provider Name | Dr. Travis J Dwyer |
First Address | Wilmington, DE 19805-2690 |
Second Address | Wilmington, DE 19805-2690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 27/05/2016 |