Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 9559 | SD |
N | 2086S0105X | Surgery of the Hand | MD-42747 | IA |
NPI | 1538373006 |
---|---|
Provider Name | Dr. Yorell Manon-Matos |
First Address | Dakota Dunes, SD 57049-5312 |
Second Address | Dakota Dunes, SD 57049-5312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 27/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100112280 | (05) | KY |
P00946088 | RAILROAD MEDICARE (01) | KY |