Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | COA.17934-NP | OH |
NPI | 1003282328 |
---|---|
Provider Name | Robert William Jonath |
First Address | Willoughby, OH 44094-4625 |
Second Address | Willoughby, OH 44094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2015 |
Last Update Date | 16/01/2017 |