Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35094679 | OH |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 35094679 | OH |
NPI | 1194936120 |
---|---|
Provider Name | Walter P. Samora III |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43215-5577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 12/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3060217 | (05) | OH |