Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36003056W | OH |
Y | 222Z00000X | Podiatrist | 36003056W | OH |
N | 2081S0010X | Sports Medicine | 36003056W | OH |
N | 213ES0000X | Sports Medicine | 36003056W | OH |
N | 213ES0131X | Foot Surgery | 36003056W | OH |
NPI | 1114923398 |
---|---|
Provider Name | Shawn C Ward |
First Address | Lima, OH 45805-2725 |
Second Address | Lima, OH 45805-2725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2136398 | (05) | OH |
480031634 | RAILROAD MEDICARE (01) | OH |
CB6624 | RAILROAD MEDICARE (01) | |
U75335 | (02) | OH |