Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35-059898 | OH |
Y | 208600000X | Surgeon | 35-059898 | OH |
NPI | 1023095254 |
---|---|
Provider Name | Dr. Carlton Jefferson Kesler |
First Address | Maumee, OH 43537-1728 |
Second Address | Maumee, OH 43537-1728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0103328 | (05) | OH |
F32795 | (02) | OH |