Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 35050685I | OH |
NPI | 1235114174 |
---|---|
Provider Name | Rodney K. Ison |
First Address | Canal Fulton, OH 44614-8669 |
Second Address | Canal Fulton, OH 44614-8669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 03/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010034845 | RAILROAD MEDICARE (01) | OH |
0569022 | (05) | OH |
A15898 | (02) |