Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 35032586 | OH |
NPI | 1386644078 |
---|---|
Provider Name | Dr. Thomas S Main |
First Address | Columbus, OH 43214-2467 |
Second Address | Columbus, OH 43214-2467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0275063 | (05) | OH |
F13518 | (02) |