Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 279757 | MA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 279757 | MA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 52843 | AZ |
NPI | 1114232584 |
---|---|
Provider Name | Simon Gortz |
First Address | Brookline, MA 02445-6007 |
Second Address | Boston, MA 02115-6110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 05/11/2019 |