Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35043548 | OH |
NPI | 1053388892 |
---|---|
Provider Name | Robert Daniel Cevasco JR. |
First Address | Akron, OH 44308-2038 |
Second Address | Akron, OH 44304-1429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 19/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0433490 | (05) | OH |
B96551 | (02) |