Individual
SI ROATEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.T. (R)(CT)
Contact information
Practice address
115 GAYVEN DR, BALL, LA 71405-4901
(731) 267-6911
Mailing address
97 SHERWOOD DR, DRY PRONG, LA 71423-8755
Taxonomy
Speciality
Code
Description
License number
State
2471C3401X
Computed Tomography Radiologic Technologist
Primary
12633
LA
Other
Enumeration date
04/02/2018
Last updated
04/02/2018
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