Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 34005750M | OH |
NPI | 1043282684 |
---|---|
Provider Name | Dr. Tracy Lynne Shaub |
First Address | Athens, OH 45701-1359 |
Second Address | Athens, OH 45701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 05/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0165922 | (05) | OH |
F74897 | (02) | OH |