Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07000976A | IN |
Y | 222Z00000X | Podiatrist | 07000976A | IN |
NPI | 1053404046 |
---|---|
Provider Name | Dr. Robert A Amazon |
First Address | Carmel, IN 46032-2812 |
Second Address | Carmel, IN 46032-2812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 20/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000319438 | ANTHEM (01) | IN |
200439860 | (05) | IN |
U77354 | (02) | IN |