Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 35131557 | OH |
NPI | 1144546763 |
---|---|
Provider Name | Jordan M Cloyd |
First Address | Columbus, OH 43202-1579 |
Second Address | Columbus, OH 43221-3502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2010 |
Last Update Date | 26/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0236466 | (05) | OH |