Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35086927 | OH |
NPI | 1003865403 |
---|---|
Provider Name | Joseph S Colla |
First Address | Kettering, OH 45429-5164 |
Second Address | Hamilton, OH 45013-2767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000383354 | BCBS (01) | OH |
2621523 | (05) | OH |
I47487 | (02) |