Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 19071 | OH |
NPI | 1063638971 |
---|---|
Provider Name | Dr. Timothy Wayne Conley |
First Address | Cincinnati, OH 45249-2369 |
Second Address | Fairfield, OH 45014-2900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U50213 | (02) | OH |