Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01023497A | IN |
N | 208600000X | Surgeon | 01023497A | IN |
N | 2082S0105X | Plastic Hand Surgeon | 01023497A | IN |
N | 2086S0105X | Surgery of the Hand | 01023497A | IN |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 01023497A | IN |
NPI | 1104996370 |
---|---|
Provider Name | Thomas E Southern |
First Address | Cincinnati, OH 45263-7999 |
Second Address | Indianapolis, IN 46222-1672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 19/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000762785 | BCBS (01) | IN |
100073340A | (05) | IN |