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Individual
JAMES EDWIN PROMMERSBERGER
Active
Individual
JAMES EDWIN PROMMERSBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36-00-2619
OH
213ES0103X
Foot & Ankle Surgery Podiatrist
36-00-2619
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000177949
ANTHEM
OH
01
—
000601363
BLUE SHIELD MOUNTAIN STATE
WV
01
—
0099572000
MEDICAID WV
WV
05
—
0774194
—
OH
01
—
P00199462
MEDICARE TRAVELERS
OH
Enumeration date
01/31/2006
Last updated
06/02/2008
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