Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 34005913 | OH |
NPI | 1720073992 |
---|---|
Provider Name | Jacob Paul Burkhart III |
First Address | Columbus, OH 43220-2967 |
Second Address | Westerville, OH 43081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2027014 | (05) | OH |
G56924 | (02) |