Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH00001690 | WA |
N | 111NR0200X | Radiology | CH1690 | WA |
N | 213ER0200X | Radiology | CH1690 | WA |
NPI | 1639132293 |
---|---|
Provider Name | Dr. Robert Roy Failor |
First Address | Aberdeen, WA 98520-4602 |
Second Address | Aberdeen, WA 98520-4602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18188 | DEPARTMENT L&I (01) | WA |
2096204 | (05) | WA |
FA2313 | REGENCE (01) | WA |
T02618 | (02) | WA |