Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 01057494 | IN |
NPI | 1003925066 |
---|---|
Provider Name | Dr. Jiangming Xu |
First Address | Columbus, IN 47203-1545 |
Second Address | Columbus, IN 47203-1545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 30/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000315511 | ANTHEM PROV # (01) | IN |
200422330 | (05) | IN |
H91106 | (02) | IN |