Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1487010062 |
---|---|
Provider Name | Scott Vermeulen |
First Address | Davis, CA 95616-3505 |
Second Address | Davis, CA 95616-3505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2016 |
Last Update Date | 21/01/2016 |