Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30-022456 | OH |
NPI | 1063548022 |
---|---|
Provider Name | Dr. Jack B Mcewan |
First Address | Mount Vernon, OH 43050-1547 |
Second Address | Mount Vernon, OH 43050-1547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 18/12/2009 |