Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | S4133 | TX |
NPI | 1306238621 |
---|---|
Provider Name | Michael Pierce Ebaugh |
First Address | Tampa, FL 33611-1651 |
Second Address | Columbus, OH 43228-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2015 |
Last Update Date | 18/03/2020 |