Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36003100 | OH |
Y | 222Z00000X | Podiatrist | 36003100 | OH |
NPI | 1023011160 |
---|---|
Provider Name | Scott Andrew |
First Address | Fairfield, OH 45014-4670 |
Second Address | Cincinnati, OH 45242-7741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 21/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2389688 | (05) | OH |
P00254332 | RAILROAD MEDICARE (01) | OH |