Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 36002701 | OH |
NPI | 1295714012 |
---|---|
Provider Name | Lori A Fannin |
First Address | Galion, OH 44833-1923 |
Second Address | Galion, OH 44833-1923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0829198 | (05) | OH |
U19156 | (02) | OH |