Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 35053389 | OH |
NPI | 1033191911 |
---|---|
Provider Name | Dr. John J. Racciato |
First Address | Defiance, OH 43512-2440 |
Second Address | Defiance, OH 43512-2440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 17/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
626844 | (05) | OH |
A17599 | (02) | OH |