Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 218962 | MA |
Y | 207X00000X | Orthopaedic Surgeon | 218962 | MA |
NPI | 1669445243 |
---|---|
Provider Name | Walter G Stanwood |
First Address | Duxbury, MA 02332-4738 |
Second Address | Plymouth, MA 02360-4842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 01/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2017202 | (05) | MA |
H91587 | (02) | MA |
P00053230 | RAILROAD MEDICARE (01) | MA |