Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 0101236224 | VA |
N | 207VX0201X | Gynecologic Oncologist | 0101236224 | VA |
Y | 207VX0201X | Gynecologic Oncologist | 036139067 | IL |
NPI | 1518930601 |
---|---|
Provider Name | John W. Moroney |
First Address | Dayton, OH 45431-1261 |
Second Address | Dayton, OH 45431-1261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 28/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036139067 | STATE LICENSE (01) | IL |
2987184 | (05) | OH |