Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | IL |
NPI | 1174543201 |
---|---|
Provider Name | William Scott Deitche |
First Address | Fort Belvoir, VA 22060-5901 |
Second Address | Fort Belvoir, VA 22060-5901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |