Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301406830 | MI |
NPI | 1023041951 |
---|---|
Provider Name | Ben R Mayne III |
First Address | Midland, MI 48640-4722 |
Second Address | Midland, MI 48640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 04/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2738032 | (05) | MI |
E83429 | (02) | MI |