Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN10464 | FL |
NPI | 1124199450 |
---|---|
Provider Name | Dr. Robert B. Churney |
First Address | Clearwater, FL 33761-2512 |
Second Address | Clearwater, FL 33761-2512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |