Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5059 | FL |
NPI | 1093733313 |
---|---|
Provider Name | Dr. Roger Robert Verno |
First Address | Ft Lauderdale, FL 33334-4116 |
Second Address | Ft Lauderdale, FL 33334-4116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050167 | (05) | FL |
T94434 | (02) | FL |