Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101050830 | VA |
N | 207XS0117X | Orthopaedic Spine Surgeon | 0101050830 | VA |
NPI | 1124084710 |
---|---|
Provider Name | Timothy Budorick |
First Address | Virginia Beach, VA 23462 |
Second Address | Virginia Beach, VA 23454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 05/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6406033 | (05) | VA |
F04537 | (02) |