Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 07000989A | IN |
NPI | 1184601429 |
---|---|
Provider Name | Benjamin Graber Lehman |
First Address | Elkhart, IN 46514-1967 |
Second Address | Elkhart, IN 46514-1967 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07000989A | STATE LICENSE NUMBER (01) | IN |
U53470 | (02) | IN |