Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT-61 | OH |
Y | 213ES0000X | Sports Medicine | AT-61 | OH |
NPI | 1487200838 |
---|---|
Provider Name | Mr. Joseph Willard Hershey |
First Address | Fremont, OH 43420-2122 |
Second Address | Fremont, OH 43420-1132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |