Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 35079006 | OH |
NPI | 1073599973 |
---|---|
Provider Name | Dr. Roberto J Castellon |
First Address | Canal Winchester, OH 43110-8843 |
Second Address | Lancaster, OH 43130-8186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 06/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H35772 | (02) | OH |