Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 07850 | RI |
NPI | 1154368926 |
---|---|
Provider Name | Robert M Shalvoy |
First Address | Providence, RI 02901-1119 |
Second Address | Providence, RI 02906-4862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 03/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9020321 | (05) | RI |
F00022 | (02) |