Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 134 | SD |
Y | 222Z00000X | Podiatrist | 134 | SD |
NPI | 1043216955 |
---|---|
Provider Name | John Elmer Forrette JR. |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57104-4647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 02/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6800402 | (05) | SD |
T61928 | (02) |