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General NPI Number Information
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NPI Number | 1134571334
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Entity Type | Individual
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Provider Name | ROBERT EZEWUIRO
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Gender | Male
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 1190 HIGHWAY 9 BYP W
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City | LANCASTER
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State | SC
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Zip | 29720-1709
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Country | US
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Telephone | 803-285-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 10800 KNIGHTS RD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-4200
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Country | US
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Telephone | 215-612-4000
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Fax | 215-612-4069
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 694
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 694
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 694
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License Number State | SC
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