Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 35.122349 | OH |
NPI | 1013120633 |
---|---|
Provider Name | Toby Lees |
First Address | Wpafb, OH 45433-5529 |
Second Address | Wpafb, OH 45433-5529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 06/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0114758 | (05) | OH |