Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 35-067068 | OH |
NPI | 1184600512 |
---|---|
Provider Name | Dr. John C O'connor |
First Address | Bellefontaine, OH 43311-9036 |
Second Address | Bellefontaine, OH 43311-9036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 27/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F97049 | (02) | OH |