Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 30025316 | OH |
N | 213EG0000X | General Practice | 30025316 | OH |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 30025316 | OH |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 30025316 | OH |
NPI | 1184126096 |
---|---|
Provider Name | Dr. Eber Luis Lima Stevao |
First Address | Pickerington, OH 43147-8237 |
Second Address | Pickerington, OH 43147-8237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |