Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 54085 | OH |
NPI | 1659357226 |
---|---|
Provider Name | Dr. Annette Karen Boer |
First Address | Columbus, OH 43220-4722 |
Second Address | Grove City, OH 43123-3993 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 08/07/2007 |