Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35089257 | OH |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 35089257 | OH |
NPI | 1356472484 |
---|---|
Provider Name | Dr. Vince T Wake |
First Address | Canton, OH 44718-3603 |
Second Address | Canton, OH 44718-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 05/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2890028 | (05) | OH |