Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 00350 | WV |
NPI | 1346350030 |
---|---|
Provider Name | Gerald Marshall Erskine |
First Address | Ronceverte, WV 24970-1320 |
Second Address | Ronceverte, WV 24970-1320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 03/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T89098 | (02) | WV |