Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 35044223 | OH |
NPI | 1477555258 |
---|---|
Provider Name | Dr. Ravi Surya Devara |
First Address | Dayton, OH 45429-1977 |
Second Address | Dayton, OH 45429-1977 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0552370 | (05) | OH |
C02706 | (02) | OH |