Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 46573 | TN |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 35.088383 | OH |
NPI | 1346300258 |
---|---|
Provider Name | Craig F Shank |
First Address | Dayton, OH 45404-1815 |
Second Address | Dayton, OH 45404-1815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 25/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2755059 | (05) | OH |