Individual
JAMES EDWIN PROMMERSBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
940 WINDHAM CT, SUITE #3, BOARDMAN, OH 44512-5060
(330) 726-3348
(330) 726-3856
Mailing address
940 WINDHAM CT, SUITE #3, BOARDMAN, OH 44512-5060
(330) 726-3348
(330) 726-3856
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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