Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 35063683 | OH |
NPI | 1841290582 |
---|---|
Provider Name | Darryl Willett |
First Address | Columbus, OH 43220-2967 |
Second Address | Columbus, OH 43214-2467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000542273 | ANTHEM (01) | |
02296649 | (05) | OH |
G22050 | (02) | OH |