Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 35020555T | OH |
NPI | 1326240722 |
---|---|
Provider Name | Dr. Sam Ernest Tochtenhagen |
First Address | Mc Donald, OH 44437-1549 |
Second Address | Mc Donald, OH 44437-1549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |