Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0401005738 | VA |
NPI | 1134104649 |
---|---|
Provider Name | Raymond Gerard Morin |
First Address | Beaufort, SC 29902-6148 |
Second Address | Beaufort, SC 29902-6148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 03/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000OTH | (02) |