Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1841481991 |
---|---|
Provider Name | John M Dean |
First Address | Longview, WA 98632-3046 |
Second Address | Longview, WA 98632-3046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 05/08/2007 |