Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 35045275 | OH |
NPI | 1003806209 |
---|---|
Provider Name | James M Anthony |
First Address | Lorain, OH 44052-3781 |
Second Address | Amherst, OH 44001-1207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 20/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0487647 | (05) | OH |