Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | BP10057275 | TX |
N | 208600000X | Surgeon | BP10057275 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD446563 | PA |
NPI | 1295051381 |
---|---|
Provider Name | Sean Michael Devitt |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-4824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2010 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
650707 | TEXAS TRAINING PERMIT (01) | TX |