Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 35.139036 | OH |
NPI | 1033434097 |
---|---|
Provider Name | Robert J Beaulieu |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43221-2849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2010 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0409802 | (05) | OH |