Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1548535115 |
---|---|
Provider Name | Mr. Jimmy Ray Royall |
First Address | Yadkinville, NC 27055-1138 |
Second Address | Winston Salem, NC 27103-6813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2012 |
Last Update Date | 31/01/2017 |