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Technologists, Technicians & Other Technical Service Providers Radiologic Technologist Sonography

Provider NPI: 1114230638

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
2505 WARRIORS TRL #5 VICKSBURG, MS 39180-7207 US
Tel: 760-669-9602  Fax: --

Business Mailing Address:
2505 WARRIORS TRL #5 VICKSBURG, MS 39180-7207 US
Tel: 760-669-9602  Fax: --

NPI Information:
NPI: 1114230638
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y2471S1302XTechnologists, Technicians & Other Technical Service Providers
Radiologic Technologist

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 2471S1302X





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