Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 19061 | OH |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 5949 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 5949 | KY |
NPI | 1235146101 |
---|---|
Provider Name | Dr. Jerry Alan Mayer |
First Address | Ironton, OH 45638 |
Second Address | Ironton, OH 45638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 16/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0751575 | (05) | OH |
60059490 | DENTAL PROVIDER NUMBER (01) | KY |
64059496 | MEDICAL PROVIDER NUMBER (01) | KY |
T54104 | (02) |