Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 120107744A | IN |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 5633-015 | WI |
NPI | 1043308968 |
---|---|
Provider Name | Dr. Matthew D Bojrab |
First Address | Fishers, IN 46038-2637 |
Second Address | Fishers, IN 46038-2637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 31/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200847900 | (05) | IN |
V11120 | (02) | IN |