Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 0101-045754 | VA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 0101045754 | VA |
NPI | 1336118488 |
---|---|
Provider Name | Larry Dennis |
First Address | Roanoke, VA 24013-2222 |
Second Address | Roanoke, VA 24013-2222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 01/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6217290 | (05) | VA |
6242715 | (05) | VA |
E68004 | (02) | VA |