Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 35059182 | OH |
NPI | 1023129038 |
---|---|
Provider Name | Stephen W Fannin |
First Address | Akron, OH 44304-1437 |
Second Address | Akron, OH 44304-1437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0142116 | (05) | OH |
G02365 | (02) | OH |