Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35-05-0323 | OH |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35050323 | OH |
NPI | 1578531547 |
---|---|
Provider Name | Lloyd David Dennis |
First Address | Marietta, OH 45750-0449 |
Second Address | Vincent, OH 45784-9117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 04/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0052598000 | (05) | WV |
0606491 | (05) | OH |
A16149 | (02) |