Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01057188A | IN |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 01057188A | IN |
NPI | 1225031206 |
---|---|
Provider Name | Gregory M Sassmannshausen |
First Address | Fort Wayne, IN 46801-2526 |
Second Address | Fort Wayne, IN 46804-4133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 07/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000279430 | ANTHEM (01) | |
200046124 | RAILROAD MEDICARE (01) | |
200421590A | (05) | IN |
H78303 | (02) | IN |