Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | D22289 | MD |
N | 207XS0106X | Orthopaedic Hand Surgeon | D22289 | MD |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | D22289 | MD |
N | 207XS0117X | Orthopaedic Spine Surgeon | D22289 | MD |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D22289 | MD |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | D22289 | MD |
N | 207XX0801X | Orthopaedic Trauma Surgeon | D22289 | MD |
NPI | 1841256054 |
---|---|
Provider Name | Dr. John Edward Kenzora |
First Address | Baltimore, MD 21207-6665 |
Second Address | Baltimore, MD 21201-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 14/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1841256054 | NPI (01) | MD |
305331800 | (05) | MD |
A66046 | (02) | MD |