Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401-005798 | VA |
Y | 213EG0000X | General Practice | 0401-005798 | VA |
NPI | 1003926940 |
---|---|
Provider Name | Dr. Roy S Shelburne |
First Address | Jonesville, VA 24263-8085 |
Second Address | Bristol, VA 24202-4317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 06/03/2017 |