Individual
JENNIFER O MYTAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0102205171
VA
207L00000X
Anesthesiology Physician
Primary
DO2956
ME
207R00000X
Internal Medicine Physician
58.005415
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2014
Last updated
02/21/2025
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