Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME 97677 | FL |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | ME 97677 | FL |
Y | 207XX0801X | Orthopaedic Trauma Surgeon | 258179 | NY |
NPI | 1073522652 |
---|---|
Provider Name | John P Ketz |
First Address | Rochester, NY 14642 |
Second Address | Rochester, NY 14642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 07/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073522652 | (05) | VA |
27844830-0 | (05) | FL |
310407 | AVMED (01) | FL |
5918946 | CIGNA (01) | FL |
96123 | BLUE CROSS/BLUE SHIELD (01) | FL |