Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 20663 | WV |
Y | 208D00000X | General Practice Physician | 20663 | WV |
NPI | 1023076213 |
---|---|
Provider Name | James Lloyd Rising |
First Address | Delray, WV 26714-9701 |
Second Address | Baker, WV 26801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 28/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023076213 | NPI (01) | |
1840098000 | (05) | WV |
G21710 | (02) | WV |