Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 57.028645 | OH |
NPI | 1356794861 |
---|---|
Provider Name | Dr. Mathieu Bergeron |
First Address | Cincinnati, OH 45202-2712 |
Second Address | Cincinnati, OH 45202-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2016 |
Last Update Date | 20/07/2016 |