Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0101037753 | VA |
NPI | 1053315077 |
---|---|
Provider Name | Jeffrey Allen Rebman |
First Address | Richmond, VA 23235-4730 |
Second Address | Richmond, VA 23235-4730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 28/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7517505 | (05) | VA |
B06103 | (02) |