Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 30.025891 | OH |
NPI | 1467846824 |
---|---|
Provider Name | Wallace Sigmon Mclaurin |
First Address | Cincinnati, OH 45206-1785 |
Second Address | Cincinnati, OH 45219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 16/07/2019 |