Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 065094 | GA |
NPI | 1104897081 |
---|---|
Provider Name | Dr. John Z. Chrabuszcz |
First Address | Macon, GA 31210-2404 |
Second Address | Macon, GA 31210-2404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 27/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065094 | GA LICENSE 065094 (01) | GA |
377240234A | (05) | GA |