Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 036094700 | IL |
NPI | 1215902986 |
---|---|
Provider Name | Dr. George T Nahass |
First Address | Freeburg, IL 62243-4039 |
Second Address | Mount Vernon, IL 62864-6293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 10/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F32709 | (02) | IL |