Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | 35.091957 | OH |
NPI | 1366561292 |
---|---|
Provider Name | George C Skandamis |
First Address | Dublin, OH 43017-5325 |
Second Address | Dublin, OH 43017-5325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 20/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2849725 | (05) | OH |
5315018697 | CONTROLLED SUBSTANCE LICE (01) | MI |