Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN10613 | FL |
NPI | 1003823394 |
---|---|
Provider Name | Dr. Daryl Jon Roy |
First Address | Oakland Park, FL 33308-5105 |
Second Address | Oakland Park, FL 33308-5105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 03/03/2013 |