Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFTS01245 | NC |
NPI | 1760771828 |
---|---|
Provider Name | Raymond Derwin Jones |
First Address | Smithfield, NC 27577-8794 |
Second Address | Smithfield, NC 27577-8794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 23/05/2011 |