Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 34-008446 | OH |
N | 208600000X | Surgeon | 34-008446 | OH |
Y | 2086S0129X | Vascular Surgeon | 34-008446 | OH |
NPI | 1083669097 |
---|---|
Provider Name | Joseph G Protain |
First Address | Boardman, OH 44512-5004 |
Second Address | Boardman, OH 44512-5004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 10/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2688846 | (05) | OH |
I58195 | (02) | |
P00067987 | RR MEDICARE (01) | OH |