Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 35056916 | OH |
NPI | 1811974348 |
---|---|
Provider Name | Theodore V Parran |
First Address | Cleveland, OH 44115-3111 |
Second Address | Cleveland, OH 44115-3111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 17/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000135960 | ANTHEM (01) | OH |
0704116 | (05) | OH |
D73870 | (02) | OH |