Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 17221 | OH |
NPI | 1083775795 |
---|---|
Provider Name | Dr. Timothy Vincent Monroe |
First Address | Athens, OH 45701-1819 |
Second Address | Athens, OH 45701-1819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |