Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 34-006680 | OH |
NPI | 1134104375 |
---|---|
Provider Name | Susan Schrimpf Davis |
First Address | Cincinnati, OH 45263-6256 |
Second Address | Cincinnati, OH 45215-4406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 13/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2158801 | (05) | OH |
G92742 | (02) |