Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 34-00-4553 | OH |
NPI | 1316930100 |
---|---|
Provider Name | Dr. John Joseph Vargo |
First Address | Austintown, OH 44515-1820 |
Second Address | Austintown, OH 44515-1820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 17/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0744190 | (05) | OH |
E45708 | (02) | OH |