Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC001722L | PA |
Y | 222Z00000X | Podiatrist | SC001722L | PA |
NPI | 1013953348 |
---|---|
Provider Name | Dr. Steven D Ravert |
First Address | Sunbury, PA 17801-2711 |
Second Address | Sunbury, PA 17801-2711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 09/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001638462 | (05) | PA |
0666660001 | DME (01) | PA |
T29314 | (02) | PA |