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General NPI Number Information
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NPI Number | 1689666331
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Entity Type | Individual
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Provider Name | WILLIAM M DUTCH JR. DPM
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Gender | Male
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 6700 KIRKVILLE RD STE 202
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9305
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Country | US
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Telephone | 315-701-2929
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Fax | 315-701-1473
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Provider Business Mailing Address
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Address Line | 6700 KIRKVILLE RD SUITE C-202
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9305
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Country | US
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Telephone | 315-701-2929
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Fax | 315-701-1473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N005690
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License Number State | NY
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