Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 22480 | SC |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 22480 | SC |
NPI | 1053328682 |
---|---|
Provider Name | Mr. Jon P Devries |
First Address | North Charleston, SC 29406-9167 |
Second Address | North Charleston, SC 29406-9167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 24/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H38158 | (02) | |
T67308 | (05) | SC |