Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 0401005565 | VA |
NPI | 1033135926 |
---|---|
Provider Name | Dr. George Kevorkian JR. |
First Address | Vinton, VA 24179-2105 |
Second Address | Vinton, VA 24179-2105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |