Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36.001549 | OH |
Y | 222Z00000X | Podiatrist | 36.001549 | OH |
NPI | 1053339374 |
---|---|
Provider Name | Richard Shramo |
First Address | Bellefontaine, OH 43311-0341 |
Second Address | Bellefontaine, OH 43311-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 27/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000005223 | ANTHEM (01) | OH |
0198718 | (05) | OH |
T80367 | (02) | OH |