Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.040831 | OH |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 35.040831 | OH |
NPI | 1760465850 |
---|---|
Provider Name | Dr. Raymond B Coors JR. |
First Address | Cincinnati, OH 45212-3359 |
Second Address | Cincinnati, OH 45231-3828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 30/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000008695 | ANTHEM ID (01) | OH |
0585488 | (05) | OH |
1020172 | UNITED HEALTHCARE ID (01) | OH |
4026133 | AETNA ID (01) | OH |
4033107 | HUMANA ID (01) | OH |