Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 306751 | LA |
Y | 213ES0000X | Sports Medicine | 306751 | LA |
NPI | 1104342385 |
---|---|
Provider Name | Mr. Justin Alexander Rohrman |
First Address | Monroe, LA 71203 |
Second Address | Monroe, LA 71203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2017 |
Last Update Date | 18/08/2017 |