Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 30014974 | OH |
Y | 213EG0000X | General Practice | 30014974 | OH |
NPI | 1003902131 |
---|---|
Provider Name | Dr. Joseph Paul Mayer JR. |
First Address | Cincinnati, OH 45208-2317 |
Second Address | Cincinnati, OH 45208-2317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0299887 | (05) | OH |
30014974 | STATE DENTAL LICENSE (01) | OH |
DT-1980 | STATE DENTAL LICENSE (01) | HI |