Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 34008630 | OH |
Y | 207QS0010X | Family Doctor - Sports Medicine | 34-008630 | OH |
NPI | 1053369728 |
---|---|
Provider Name | Royce B Sanchez |
First Address | Camp Lejeune, NC 28547-2538 |
Second Address | Camp Lejeune, NC 28547-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 29/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1841239274 | MEDICARE GROUP NPI NUMBER (01) | OH |
2551671 | MEDICAID GROUP # (01) | OH |
2774967 | (05) | OH |
9338635 | MEDICARE GROUP NUMBER (01) | OH |