Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 15951 | WV |
Y | 207VX0201X | Gynecologic Oncologist | 15951 | WV |
NPI | 1306969480 |
---|---|
Provider Name | Timothy Guiney Deeulis |
First Address | Huntington, WV 25702-1236 |
Second Address | Huntington, WV 25702-1236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 28/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0091663000 | (05) | WV |
0709282 | (05) | OH |
B41089 | (02) |