Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 116144 | MO |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 116144 | MO |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 5101017139 | MI |
NPI | 1437122744 |
---|---|
Provider Name | Tracy C Orton |
First Address | Holland, MI 49424-8122 |
Second Address | Holland, MI 49424-8122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1437122744 | (05) | MI |
701000217 | MO MEDICARE (01) | MO |
D16150188 | MEDICARE PROVIDER NUMBER (01) | MI |
H02945 | (02) |