Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 36740 | SC |
NPI | 1003074733 |
---|---|
Provider Name | Ryan Corbin Zitzke |
First Address | Atlanta, GA 30374-3904 |
Second Address | Sumter, SC 29150-4975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 02/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
367409 | (05) | SC |