Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0980404 | OH |
NPI | 1023091113 |
---|---|
Provider Name | Richard Allen Fankhauser |
First Address | Columbus, OH 43222-1548 |
Second Address | Columbus, OH 43222-1548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 12/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0485863 | (05) | OH |
0900871 | DMERC (01) | OH |
A80339 | (02) | OH |