Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 35.074657 | OH |
NPI | 1407935000 |
---|---|
Provider Name | Mr. Paul Anthony Dibiase JR. |
First Address | Steubenville, OH 43952 |
Second Address | Steubenville, OH 43952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 05/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2073983 | (05) | OH |
3810029289 | (05) | WV |
G76975 | (02) |