Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 036043321 | IL |
Y | 207WX0107X | Retina Specialist | 036043321 | IL |
NPI | 1043210750 |
---|---|
Provider Name | David H Orth |
First Address | Harvey, IL 60426-4265 |
Second Address | Harvey, IL 60426-4265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 15/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036043321 | (05) | IL |
182910100 | RRMC (01) | IL |
C41327 | (02) |