Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 1257 | WV |
NPI | 1275534653 |
---|---|
Provider Name | Nick Ghaphery |
First Address | St Clairsville, OH 43950 |
Second Address | St Clairsville, OH 43950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0053105000 | (05) | WV |
0848275 | (05) | OH |
F21087 | (02) |