Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401414513 | VA |
Y | 213EG0000X | General Practice | 0401414513 | VA |
NPI | 1003216151 |
---|---|
Provider Name | Dr. James Ryland Gwaltney |
First Address | Suffolk, VA 23434-4206 |
Second Address | Suffolk, VA 23434-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 26/08/2014 |