Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 125.079053 | IL |
NPI | 1003484809 |
---|---|
Provider Name | Joseph Robert Rojas |
First Address | Aurora, IL 60504-5894 |
Second Address | Aurora, IL 60504-5894 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2021 |
Last Update Date | 29/06/2021 |