Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | TN | |
N | 225000000X | Orthotic Fitter | TN |
NPI | 1184158768 |
---|---|
Provider Name | Mr. Donald Ray Box JR. |
First Address | Memphis, TN 38119-4878 |
Second Address | Memphis, TN 38119-4878 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2017 |
Last Update Date | 20/04/2017 |