Healthcare Provider Details

I. General information

NPI: 1174519037
Provider Name (Legal Business Name): JOHN DOUGLAS ROYALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 AVE OF TWO RIVERS
RUMSON NJ
07760-1802
US

IV. Provider business mailing address

108 AVE OF TWO RIVERS
RUMSON NJ
07760-1802
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-0591
  • Fax: 732-747-8343
Mailing address:
  • Phone: 732-747-0591
  • Fax: 732-747-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA03272600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: