Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT005702 | OH |
Y | 213ES0000X | Sports Medicine | AT005702 | OH |
NPI | 1205484060 |
---|---|
Provider Name | Isaiah Mast |
First Address | Alliance, OH 44601-3929 |
Second Address | Alliance, OH 44601-3929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2019 |
Last Update Date | 26/08/2019 |