Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0401005057 | VA |
NPI | 1194782052 |
---|---|
Provider Name | Dr. Marvin Eugene Perdue |
First Address | Rocky Mount, VA 24151-5647 |
Second Address | Rocky Mount, VA 24151-5647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |