Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD23728 | ME |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MA79171 | MA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | ME121606 | FL |
NPI | 1710958723 |
---|---|
Provider Name | Henry Degroot III |
First Address | Newton, MA 02462-1650 |
Second Address | Newton, MA 02462-1650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 17/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F24634 | (02) | MA |