Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | P6711 | TX |
NPI | 1154655876 |
---|---|
Provider Name | Dr. Jay Roop |
First Address | Roanoke, TX 76262-1578 |
Second Address | Fort Worth, TX 76107-2644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2009 |
Last Update Date | 03/09/2021 |