Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 57.249102 | OH |
NPI | 1073134243 |
---|---|
Provider Name | Ryan John Ivancic |
First Address | Columbus, OH 43212-3154 |
Second Address | Columbus, OH 43212-3154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2020 |
Last Update Date | 29/04/2020 |