Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 35089927 | OH |
NPI | 1124148846 |
---|---|
Provider Name | Dr. Thomas Robert Breen |
First Address | Independence, OH 44131-5057 |
Second Address | Independence, OH 44131-5032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 02/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2939413 | (05) | OH |
4265001 | MEDICARE ID (01) | OH |