Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 97-397 | NM |
Y | 208600000X | Surgeon | 97-397 | NM |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 97--397 | NM |
NPI | 1003858515 |
---|---|
Provider Name | Poseidon Spyros Varvitsiotis |
First Address | Santa Fe, NM 87505-4728 |
Second Address | Santa Fe, NM 87505-4728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 23/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000R6782 | (05) | NM |
G58727 | (02) | NM |