Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E3467 | CA |
Y | 222Z00000X | Podiatrist | E3467 | CA |
N | 111NR0200X | Radiology | E3467 | CA |
N | 213ER0200X | Radiology | E3467 | CA |
N | 213ES0103X | Foot & Ankle Surgery | E34670 | CA |
NPI | 1104829431 |
---|---|
Provider Name | Kevin Irving Stroh |
First Address | Lodi, CA 95242-3037 |
Second Address | Lodi, CA 95242-3037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 19/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E34670 | (05) | CA |
T90634 | (02) | CA |