Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1023360823 |
---|---|
Provider Name | Jeffery J Roy |
First Address | Baraga, MI 49908-9698 |
Second Address | Marquette, MI 49855-3186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2012 |
Last Update Date | 04/10/2012 |