Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 34002237 | OH |
NPI | 1083693998 |
---|---|
Provider Name | Carl Ray Backes |
First Address | Columbus, OH 43205-2654 |
Second Address | Columbus, OH 43205-2654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 25/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0263941 | (05) | OH |
64783160 | (05) | KY |
C02615 | (02) |