Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1063184414 |
---|---|
Provider Name | Mr. Alex G Trumper |
First Address | Peru, NY 12972-2633 |
Second Address | Plattsburgh, NY 12901-1785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2021 |
Last Update Date | 04/10/2021 |