Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 34.009569 | OH |
N | 207YS0123X | Facial Plastic Surgeon | 58.001596 | OH |
NPI | 1558579839 |
---|---|
Provider Name | Dr. Christopher Howard Hetrick |
First Address | Mount Vernon, OH 43050-1440 |
Second Address | Mount Vernon, OH 43050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 15/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2999368 | (05) | OH |