Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 36003153 | OH |
NPI | 1083694301 |
---|---|
Provider Name | Richard F Jennings |
First Address | Bellefontaine, OH 43311-1581 |
Second Address | Bellefontaine, OH 43311-1581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 21/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H159820 | MEDICARE (01) | OH |