Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MD0000043266 | TN |
NPI | 1013165125 |
---|---|
Provider Name | Dr. Brian Arthur Rovira |
First Address | Unicoi, TN 37692-0459 |
Second Address | Unicoi, TN 37692-0459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 29/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A34076 | (02) | CA |