Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 35.099449 | OH |
Y | 2084N0402X | Child Neurologist | 35.099449 | OH |
N | 2084N0600X | Clinical Neurophysiologist | 35.099449 | OH |
NPI | 1063625234 |
---|---|
Provider Name | John R Mytinger |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 10/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0066559 | (05) | OH |
H147850 | MEDICARE - CGS (01) | OH |