Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2305207211 | VA |
NPI | 1043588932 |
---|---|
Provider Name | Jaison William Alderman |
First Address | Great Falls, VA 22066-2650 |
Second Address | Great Falls, VA 22066-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2011 |
Last Update Date | 17/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043588932 | NPI (01) | VA |