Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1164628806 |
---|---|
Provider Name | Mr. Roy Lee Coggin |
First Address | Farmville, NC 27828-0690 |
Second Address | Farmville, NC 27828-1434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 15/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795254 | (05) | NC |
7795300 | (05) | NC |