| NPI | 1689600447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER BAILEY Credentialing Specialist 804-571-5106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101036726) |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery, Hand Surgery (Licence: VA 0101226595) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: VA 0101231604) | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: VA 0101237849) | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: VA 0101045456) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101052925) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2019-06-11 |