Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 35038754 | OH |
NPI | 1013016062 |
---|---|
Provider Name | Dr. Victor N Nanagas JR. |
First Address | Kettering, OH 45429 |
Second Address | Dayton, OH 45404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 01/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0388496 | (05) | OH |