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Individual
MR. TROY ROBERT PRENTICE
Active
Individual
MR. TROY ROBERT PRENTICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0110008603
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A67227225
DRIVERS LICENSE NUMBER
VA
Enumeration date
05/15/2022
Last updated
06/30/2022
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