Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | C36341 | MD |
Y | 222Z00000X | Podiatrist | C36341 | MD |
N | 2081S0010X | Sports Medicine | C36341 | MD |
N | 213ES0000X | Sports Medicine | C36341 | MD |
NPI | 1083852552 |
---|---|
Provider Name | Mr. Von Maurice Homer |
First Address | Reisterstown, MD 21136-3651 |
Second Address | Reisterstown, MD 21136-3651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2009 |
Last Update Date | 22/01/2009 |