Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PRO0000000031 | TN |
NPI | 1225569221 |
---|---|
Provider Name | Jeff Roberts |
First Address | Chattanooga, TN 37406-3603 |
Second Address | Chattanooga, TN 37406-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 07/04/2017 |