Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | DP155136 | OR |
NPI | 1053543967 |
---|---|
Provider Name | Micah D Tovey |
First Address | Roseburg, OR 97471-2348 |
Second Address | Roseburg, OR 97471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2009 |
Last Update Date | 22/09/2020 |