Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 34.009281 | OH |
N | 207N00000X | Dermatologist | 5101016570 | MI |
N | 207NS0135X | Procedural Dermatology | 34.009281 | OH |
NPI | 1053534172 |
---|---|
Provider Name | Mr. Ryan M. Carlson |
First Address | Dublin, OH 43017-3566 |
Second Address | Grove City, OH 43123-4835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 04/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2851301 | (05) | OH |