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General NPI Number Information
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NPI Number | 1043202187
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Entity Type | Individual
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Provider Name | ESTHER GRACE PABLO KANAYJORN MD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 1092 JEFFERSON ST
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City | GREENFIELD
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State | OH
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Zip | 45123-8319
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Country | US
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Telephone | 937-981-1121
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Fax | 937-981-5660
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Provider Business Mailing Address
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Address Line | 104 ERIN COURT
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City | HILLSBORO
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State | OH
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Zip | 45133-0070
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Country | US
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Telephone | 937-393-5781
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Fax | 937-393-5784
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35077853-K
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License Number State | OH
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