Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 35-091391 | OH |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 35 091391 | OH |
NPI | 1215011184 |
---|---|
Provider Name | Mary South |
First Address | Akron, OH 44320-1178 |
Second Address | Akron, OH 44320-1178 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200911640 | (05) | IN |
2859812 | (05) | OH |
5901063 | (05) | NC |
7100056360 | (05) | KY |
I32762 | (02) |