Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 36-00-3103-L | OH |
NPI | 1598762692 |
---|---|
Provider Name | Brock Armstrong Liden |
First Address | Pickerington, OH 43147-0693 |
Second Address | Circleville, OH 43113-1498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2095281 | (05) | OH |
7887840001 | NATIONAL SUPPLIER CLEARINGHOUSE (01) | OH |
P00287259 | RR MEDICARE R PIN (01) | |
U72332 | (02) | OH |