Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 38MC00571900 | NJ |
N | 111NR0400X | Rehabilitation Chiropractor | 38MC00571900 | NC |
N | 111NS0005X | Chiropractic Sports Physician | 38MC00571900 | NJ |
NPI | 1346450202 |
---|---|
Provider Name | Dr. Luke E Fogg JR. |
First Address | Woodstown, NJ 08098-1408 |
Second Address | Woodstown, NJ 08098-1408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2465779 | AETNA (01) | NJ |