Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 04920 | VA |
NPI | 1437144789 |
---|---|
Provider Name | Dr. James H Priest |
First Address | South Boston, VA 24592-5200 |
Second Address | South Boston, VA 24592-5200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005261 | ANTHEM (01) | |
14941 | DORAL (01) | |
T90540 | (02) |