Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35081549 | OH |
NPI | 1003815689 |
---|---|
Provider Name | Dr. Jason L Rich |
First Address | Amanda, OH 43102-9711 |
Second Address | Amanda, OH 43102-9711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 01/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2389106 | (05) | OH |
420977 | (05) | OH |
FR2930940/XR2930940 | DEA (01) | OH |
Y31134 | (02) |