Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 35097446 | OH |
NPI | 1093908840 |
---|---|
Provider Name | James Gasparine |
First Address | Zanesville, OH 43701-1721 |
Second Address | Zanesville, OH 43701-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2007 |
Last Update Date | 03/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0051428 | (05) | OH |