Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | OH 595 | OH |
NPI | 1407903628 |
---|---|
Provider Name | Dr. Neil R Dufore |
First Address | Ironton, OH 45638-2284 |
Second Address | Ironton, OH 45638-2284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 04/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
311183283-00 | OHIO WORKERS COMPENSATION (01) | OH |
31-11832834001 | BLUE CROSS OF OHIO (01) | OH |
792350184 | RAILROAD MEDICARE (01) | OH |
T-47000 | (02) | OH |