Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 35052492C | OH |
NPI | 1205833589 |
---|---|
Provider Name | Dr. Robert Corgan |
First Address | Cincinnati, OH 45238-5302 |
Second Address | Cincinnati, OH 45219-1018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A17031 | (02) | OH |