Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 34008358 | OH |
NPI | 1649244971 |
---|---|
Provider Name | Dr. James Leigh Laub |
First Address | Beavercreek, OH 45431-3820 |
Second Address | Beavercreek, OH 45431-3820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 22/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2532923 | (05) | OH |
I20275 | (02) | OH |