Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 35084685 | OH |
N | 207VG0400X | Gynecologist | 35-084685 | OH |
N | 208800000X | Urologist | 35-084685 | OH |
NPI | 1285829101 |
---|---|
Provider Name | Dr. Arlan Marcus Gustilo-Ashby |
First Address | Centerville, OH 45459-4056 |
Second Address | Centerville, OH 45459-4056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2007 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2559315 | (05) | OH |
H71388 | (02) |