Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 04290 | OH |
NPI | 1063410843 |
---|---|
Provider Name | Joseph C Theriault |
First Address | Toledo, OH 43606-3895 |
Second Address | Toledo, OH 43606-3895 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 19/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000031422 | ANTHEM (01) | OH |
05225 | PARAMOUNT (01) | OH |
2065045 | (05) | OH |
344428256 | BEECHSTREET (01) | OH |
344428256 | FRONTPATH (01) | OH |
344428256090 | CARESOURCE (01) | OH |
3471545 | (05) | MI |
59771 | (02) | OH |