Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 35120904 | OH |
NPI | 1063661262 |
---|---|
Provider Name | Dr. John Vernon Houghtaling |
First Address | Toledo, OH 43615-2068 |
Second Address | Toledo, OH 43615-2068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2008 |
Last Update Date | 26/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H224350 | PTAN (01) | OH |