| NPI | 1205596665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA TAYLOR Credentialing Coordinator 304-399-4405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery, Hand Surgery |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 363AS0400X Physician Assistant, Surgical | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2021-12-28 |