Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01071093A | IN |
N | 207X00000X | Orthopaedic Surgeon | 35.090622 | OH |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 01071093A | IN |
N | 207XS0106X | Orthopaedic Hand Surgeon | 35.090622 | OH |
NPI | 1093997066 |
---|---|
Provider Name | Steven Robert Eddy |
First Address | Fort Wayne, IN 46801-2526 |
Second Address | Fort Wayne, IN 46804-4133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2007 |
Last Update Date | 10/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000766688 | ANTHEM (01) | |
0084595 | (05) | OH |
201080990 | (05) | IN |
P01130654 | RAILROAD MEDICARE (01) |