Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2901009843 | MI |
NPI | 1023138724 |
---|---|
Provider Name | Dr. Robert A Hershey |
First Address | East Lansing, MI 48823-6352 |
Second Address | East Lansing, MI 48823-6352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1953360030 | BCBS MEDICAL PIN# (01) | MI |
2901009843 | LICENSE # (01) | MI |