Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 11006 | SD |
NPI | 1336584630 |
---|---|
Provider Name | Jeffrey Alan Dorrity |
First Address | Watertown, SD 57201-7231 |
Second Address | Watertown, SD 57201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 02/08/2018 |