Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 065169 | GA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 065169 | GA |
NPI | 1073847794 |
---|---|
Provider Name | Dr. Sourendra Raut |
First Address | Cumming, GA 30041 |
Second Address | Cumming, GA 30041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2009 |
Last Update Date | 28/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003100343A | (05) | GA |
003100434B | (05) | GA |
003100434C | (05) | GA |