Provider Demographics
NPI:1700601838
Name:STUDER, HENRY ERVIN
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:ERVIN
Last Name:STUDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 KIDRON RD
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-9201
Mailing Address - Country:US
Mailing Address - Phone:330-328-2782
Mailing Address - Fax:
Practice Address - Street 1:358 KIDRON RD
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-9201
Practice Address - Country:US
Practice Address - Phone:330-328-2782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS599518172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver