Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30-01-9443 | OH |
NPI | 1033163886 |
---|---|
Provider Name | Dr. Terry B Philibin |
First Address | Warren, OH 44484-2460 |
Second Address | Warren, OH 44484-2460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U57584 | (02) | OH |