Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 35075876 | OH |
NPI | 1255317475 |
---|---|
Provider Name | Dr. Cornel C Van Gorp |
First Address | Upper Sandusky, OH 43351-1098 |
Second Address | Upper Sandusky, OH 43351-1098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 15/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
157068102 | (05) | TX |
G53387 | (02) | TX |