Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2009-00311 | NC |
N | 111NI0900X | Internist | 2009-00311 | NC |
N | 207RI0200X | Infectious Disease | 35.124275 | OH |
N | 208000000X | Pediatrician | 2009-00311 | NC |
N | 208000000X | Pediatrician | 30187 | AL |
Y | 2080P0208X | Pediatric Infectious Diseases | 35.124275 | OH |
NPI | 1568683548 |
---|---|
Provider Name | Grant Paulsen |
First Address | Cincinnati, OH 45229-3026 |
Second Address | Cincinnati, OH 45229-3026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 13/05/2015 |