Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 30-01-4885 | OH |
NPI | 1639150659 |
---|---|
Provider Name | Dr. Emil D Poporad |
First Address | Canton, OH 44718-2852 |
Second Address | Canton, OH 44718-2852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 07/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0362183 | (05) | OH |
341647546 | (02) | OH |