Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.125222 | OH |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 46380 | TN |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 22299 | WV |
NPI | 1013948694 |
---|---|
Provider Name | Jeremy Clifton Cuzzourt |
First Address | Gallipolis, OH 45631-1560 |
Second Address | Proctorville, OH 45669-8163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 21/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1519145 | (05) | TN |
2667234 | (05) | OH |
3810005553 | (05) | WV |
64127202 | (05) | KY |
I54900 | (02) | |
P00324289 | RAILROAD MEDICARE (01) |