Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 34005397 | OH |
NPI | 1295710465 |
---|---|
Provider Name | Jeffrey S Tharp |
First Address | Ravenna, OH 44266-3929 |
Second Address | Ravenna, OH 44266-3929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2005 |
Last Update Date | 17/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0237121 | (05) | OH |
G08084 | (02) |