Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 18346 | OH |
NPI | 1538143508 |
---|---|
Provider Name | Dr. Mark L Billy |
First Address | Austintown, OH 44515-2437 |
Second Address | Austintown, OH 44515-2437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 07/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0242866 | (05) | OH |
U61154 | (02) |