Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01051920 | IN |
Y | 208600000X | Surgeon | 01051920 | IN |
NPI | 1013075878 |
---|---|
Provider Name | Mr. Boaz Ofek |
First Address | Fort Wayne, IN 46845-1703 |
Second Address | Huntington, IN 46750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 03/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000386735 | ANTHEM BCBS (01) | IN |
200252260 | (05) | IN |
H05130 | (02) | IN |
M400024381 | (02) | IN |