Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 02004195A | IN |
NPI | 1013151463 |
---|---|
Provider Name | Fred Anthony Lepore JR. |
First Address | Kettering, OH 45429-5164 |
Second Address | Dyer, IN 46311-1705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2009 |
Last Update Date | 20/06/2013 |