Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DO00842 | RI |
NPI | 1003229923 |
---|---|
Provider Name | John Chece |
First Address | Providence, RI 02903-4752 |
Second Address | East Providence, RI 02914-1430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2014 |
Last Update Date | 21/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DO00842 | LICENSE (01) | RI |