Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD60846859 | WA |
Y | 2086S0105X | Surgery of the Hand | MD60846859 | WA |
NPI | 1508132176 |
---|---|
Provider Name | Jacob Theodore Didesch |
First Address | Wenatchee, WA 98801-2028 |
Second Address | Wenatchee, WA 98801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 21/09/2018 |