Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0103300918 | VA |
Y | 222Z00000X | Podiatrist | 0103300918 | VA |
NPI | 1003926031 |
---|---|
Provider Name | Scott Thomas Vantre |
First Address | Richmond, VA 23226 |
Second Address | Richmond, VA 23226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010119570 | (05) | VA |
165546 | ANTHEM (01) | VA |
U98453 | (02) |