1477534006 NPI number — SUZANN K FRANER D.O.

Table of content: SUZANN K FRANER D.O. (NPI 1477534006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477534006 NPI number — SUZANN K FRANER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANER
Provider First Name:
SUZANN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477534006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1323 W 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45402-6714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-586-9733
Provider Business Mailing Address Fax Number:
937-586-9736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2351 STANLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45404-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-228-0990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34005519 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0102490 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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