Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 35.092404 | OH |
N | 2086S0120X | Pediatric Surgery | 9500178 | NC |
NPI | 1629063722 |
---|---|
Provider Name | Dr. Jeffrey C Pence |
First Address | Dayton, OH 45404-1815 |
Second Address | Dayton, OH 45404-1815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 23/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12334 | BCBS NC (01) | NC |
2881645 | (05) | OH |
370015118 | RAILROAD MEDICARE (01) | NC |
8912334 | (05) | NC |
H04700 | (02) | NC |