Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | SC005609 | PA |
NPI | 1255368429 |
---|---|
Provider Name | Louis G Izzo IV |
First Address | Jeannette, PA 15644-3422 |
Second Address | Jeannette, PA 15644-3422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 03/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001957849 | (05) | PA |
U94431 | (02) | PA |