Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 36002946 | OH |
NPI | 1053362541 |
---|---|
Provider Name | Dr. Darryl Mitchell Haycock |
First Address | Lima, OH 45805-1129 |
Second Address | Lima, OH 45805-1129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 24/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2094951 | (05) | OH |
U72571 | (02) | OH |