Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07001115A | IN |
Y | 222Z00000X | Podiatrist | 07001115A | IN |
N | 213ES0103X | Foot & Ankle Surgery | 07001115A | IN |
NPI | 1093988263 |
---|---|
Provider Name | Jeremy Patrick Spaulding |
First Address | Indianapolis, IN 46222-7604 |
Second Address | Indianapolis, IN 46219-6814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 15/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201012250 | (05) | IN |