Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 14461 | WV |
Y | 208600000X | Surgeon | 14461 | WV |
N | 2086S0102X | Surgical Critical Care | 14461 | WV |
NPI | 1083674790 |
---|---|
Provider Name | Timothy D.w. Canterbury |
First Address | Huntington, WV 25701-3656 |
Second Address | Huntington, WV 25701-3656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 22/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0124797000 | (05) | WV |
0787073 | (05) | OH |
64698491 | (05) | KY |
E19507 | (02) | WV |