Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.133844 | OH |
NPI | 1083053094 |
---|---|
Provider Name | Dr. Fernando Javier Morell Diaz |
First Address | Crestline, OH 44827-1455 |
Second Address | Ontario, OH 44906-3802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0301637 | (05) | OH |