Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 12967 | WV |
Y | 111NI0900X | Internist | 12967 | WV |
N | 207RA0401X | Internist - Addiction Medicine | 12967 | WV |
NPI | 1245273879 |
---|---|
Provider Name | Dr. Victorino Rodriguez Teleron JR. |
First Address | Charleston, WV 25304-2760 |
Second Address | Williamson, WV 25661-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 23/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64080062 | (05) | KY |
D91216 | (02) | KY |