Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 66490 | OH |
NPI | 1174559033 |
---|---|
Provider Name | Dr. David Jay Sand |
First Address | Granville, OH 43023-1231 |
Second Address | Granville, OH 43023-1231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41910 | MEDICAL LICENSE (01) | CO |
51254 | MEDICAL LICENSE (01) | NJ |
66490 | MEDICAL LICENSE (01) | OH |
ES1626 | (02) | |
MD029977E | MEDICAL LICENSE (01) | PA |