Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36002279 | OH |
Y | 222Z00000X | Podiatrist | 36002279 | OH |
NPI | 1003819848 |
---|---|
Provider Name | Joseph M Moran |
First Address | Lebanon, OH 45036-0343 |
Second Address | Lebanon, OH 45036-1937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 22/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0867138 | (05) | OH |
480013753 | RAILROAD MEDICARE (01) | OH |