Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35058701A | OH |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35.058701 | OH |
NPI | 1700830189 |
---|---|
Provider Name | J Kevin Ahern |
First Address | Springfield, OH 45504-2687 |
Second Address | Springfield, OH 45504-2687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 11/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2418119 | (05) | OH |
E75610 | (02) | OH |