Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35.134901 | OH |
NPI | 1013250794 |
---|---|
Provider Name | Justin Hastings |
First Address | Sandusky, OH 44870-5390 |
Second Address | Sandusky, OH 44870-5390 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 22/10/2018 |