Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | SC |
NPI | 1306944392 |
---|---|
Provider Name | Mr. John M Rogers |
First Address | Spartanburg, SC 29303-3151 |
Second Address | Spartanburg, SC 29303-3151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DE2516 | (05) | SC |