Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301096246 | MI |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 35.125720 | OH |
NPI | 1508166513 |
---|---|
Provider Name | Dr. Wayne Trevor, J North |
First Address | Detroit, MI 48202-2608 |
Second Address | Detroit, MI 48202-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2010 |
Last Update Date | 09/11/2016 |