Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 39255 | SC |
N | 208600000X | Surgeon | 39255 | SC |
Y | 2086X0206X | Surgical Oncologist | 35.134802 | OH |
N | 2086X0206X | Surgical Oncologist | 39255 | SC |
NPI | 1316232606 |
---|---|
Provider Name | Dr. Matthew P Doepker |
First Address | Centerville, OH 45459-1294 |
Second Address | Centerville, OH 45459-1294 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0316031 | (05) | OH |
39255 | LICENSE (01) | SC |
392550 | (05) | SC |