Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36001487 | OH |
Y | 222Z00000X | Podiatrist | 36001487 | OH |
NPI | 1023011947 |
---|---|
Provider Name | Dr. Charles Russell Marlowe JR. |
First Address | Maumee, OH 43537-1863 |
Second Address | Perrysburg, OH 43551-3120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 11/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T80341 | (02) | OH |