| NPI | 1598084212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER BAILEY Credentialing Specialist 804-571-5106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 207XS0106X Orthopaedic Surgery, Hand Surgery | |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine | |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2019-06-11 |