Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 018570 | GA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 18570 | GA |
NPI | 1912908278 |
---|---|
Provider Name | Dr. Michael Zoller |
First Address | Savannah, GA 31405-4501 |
Second Address | Savannah, GA 31405-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 01/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00132283K | (05) | GA |
D31876 | (02) |