Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 204958 | LA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.133855 | OH |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2007018704 | MO |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 35.133855 | OH |
NPI | 1225051279 |
---|---|
Provider Name | Todd Martin Brickman |
First Address | Warren, OH 44484-1055 |
Second Address | Warren, OH 44484-1055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 26/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2167405 | (05) | LA |