Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 44183 | OH |
NPI | 1013245547 |
---|---|
Provider Name | Dr. Anthony John Denisco |
First Address | Harrod, OH 45850 |
Second Address | Harrod, OH 45850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2009 |
Last Update Date | 20/11/2009 |