Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | M7793 | ID |
NPI | 1003800699 |
---|---|
Provider Name | William Scott Huneycutt |
First Address | Pocatello, ID 83201 |
Second Address | Pocatello, ID 83201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 10/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
805492000 | (05) | ID |
H02655 | (02) | ID |