Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 694 | SC |
N | 213ES0103X | Foot & Ankle Surgery | 694 | SC |
N | 213ES0131X | Foot Surgery | 694 | SC |
NPI | 1134571334 |
---|---|
Provider Name | Robert Ezewuiro |
First Address | Philadelphia, PA 19114-4200 |
Second Address | Lancaster, SC 29720-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2016 |
Last Update Date | 15/08/2019 |