Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101036892 | VA |
NPI | 1992897110 |
---|---|
Provider Name | Robert David Piat |
First Address | Martinsville, VA 24112-7381 |
Second Address | Martinsville, VA 24112-7381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B-42682 | (02) |