Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1679097117 |
---|---|
Provider Name | Ryder Doty |
First Address | Albuquerque, NM 87108-2940 |
Second Address | Albuquerque, NM 87108-2940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2017 |
Last Update Date | 26/07/2017 |