Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 030684 | GA |
N | 207KA0200X | Allergist | 030684 | GA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 030684 | GA |
NPI | 1447260633 |
---|---|
Provider Name | Dr. Ronald A Van Tuyl JR. |
First Address | Canton, GA 30114 |
Second Address | Canton, GA 30114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 11/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00509187D | (05) | GA |
E91154 | (02) |