Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 34010109 | OH |
NPI | 1144489386 |
---|---|
Provider Name | Dr. Jared Daniel Bunevich |
First Address | Warren, OH 44484-1055 |
Second Address | Warren, OH 44484-1055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 20/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0050016 | (05) | OH |
H009300 | MEDICARE PTAN (01) | OH |