Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35.072711 | OH |
Y | 208600000X | Surgeon | 35.072711 | OH |
NPI | 1013935311 |
---|---|
Provider Name | Alan T Mong |
First Address | Chillicothe, OH 45601-9031 |
Second Address | Chillicothe, OH 45601-7502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2041990 | (05) | OH |
C72573 | (02) | OH |