Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MA03040400 | NJ |
Y | 208600000X | Surgeon | 25MA03040400 | NJ |
NPI | 1013918432 |
---|---|
Provider Name | William Rough |
First Address | Marlton, NJ 08053-3193 |
Second Address | Lumberton, NJ 08048-5016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 24/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1820907 | (05) | NJ |