Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 36001570 | OH |
N | 222Z00000X | Podiatrist | 36001570 | OH |
Y | 213ES0131X | Foot Surgery | 36001570 | OH |
NPI | 1003878380 |
---|---|
Provider Name | Dr. Jon Michael Rogovin |
First Address | Canton, OH 44718-2933 |
Second Address | Canton, OH 44718-2933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 22/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0160552 | (05) | OH |
T80373 | (02) | OH |