Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0126000966 | VA |
Y | 213ES0000X | Sports Medicine | 0126000966 | VA |
NPI | 1063489946 |
---|---|
Provider Name | Mr. Ricky Randall Lapradd JR. |
First Address | Roanoke, VA 24012-1111 |
Second Address | Roanoke, VA 24015-3528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 13/06/2008 |