Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 34004176W | OH |
NPI | 1033213137 |
---|---|
Provider Name | Mr. Henry Lee Wehrum |
First Address | Columbus, OH 43212-3109 |
Second Address | Columbus, OH 43212-3109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0841763 | (05) | OH |
F10560 | (02) |