Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36001616 | OH |
Y | 222Z00000X | Podiatrist | 36001616 | OH |
NPI | 1003819731 |
---|---|
Provider Name | Larry Greiner |
First Address | Portsmouth, OH 45662-3943 |
Second Address | Portsmouth, OH 45662-3943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 05/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0187882 | (05) | OH |
480022202 | RAILROAD MEDICARE (01) | OH |