Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35.132455 | OH |
NPI | 1295029387 |
---|---|
Provider Name | Dr. Tommy John Petros |
First Address | Columbus, OH 43214-3463 |
Second Address | Columbus, OH 43214-3463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2011 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0250495 | (05) | OH |