Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 970 | OH |
NPI | 1285664672 |
---|---|
Provider Name | Dr. Charles William Lindquist |
First Address | Greenville, OH 45331-1929 |
Second Address | Greenville, OH 45331-1929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0511708 | (05) | OH |
341389381-00 | BUREAU OF WORKERS COMP (01) | OH |
T47776 | (02) | OH |