Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 254532-1 | NY |
NPI | 1992962302 |
---|---|
Provider Name | Dr. Roger Walcott |
First Address | Buffalo, NY 14214-2693 |
Second Address | Buffalo, NY 14214-2693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 23/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03138965 | (05) | NY |