Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 35.096868 | OH |
NPI | 1679586275 |
---|---|
Provider Name | John P Clancy |
First Address | Cincinnati, OH 45229-3039 |
Second Address | Cincinnati, OH 45229-3039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 21/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009969010 | (05) | AL |
051503748 | (05) | AL |
051503748 | BCBS OF AL (01) | AL |
051503749 | BCBS OF AL (01) | AL |
09523863 | MS MEDICAID (01) | AL |
290014033 | RR MEDICARE (01) | AL |