Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35-063868 | OH |
NPI | 1003907494 |
---|---|
Provider Name | Dr. William R. Marriott |
First Address | Cincinnati, OH 45209-1268 |
Second Address | Dayton, OH 45409-2722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 21/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0961375 | (05) | OH |
F75547 | (02) | OH |