Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 25087 | WV |
N | 207N00000X | Dermatologist | MD13562 | RI |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD13562 | RI |
NPI | 1316969694 |
---|---|
Provider Name | Jason Michaels |
First Address | Middletown, RI 02842-5237 |
Second Address | Middletown, RI 02842-5237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H02210 | (02) |