Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0127X | Trauma Surgeon | 036.137090 | IL |
Y | 2086S0127X | Trauma Surgeon | ME148845 | FL |
NPI | 1215248604 |
---|---|
Provider Name | Dr. James G Boron |
First Address | Marietta, GA 30066-6340 |
Second Address | Atlanta, GA 30312-1212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 07/01/2022 |