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General NPI Number Information
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NPI Number | 1982774204
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Entity Type | Organization
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Legal Business Name | RADFORD ORTHOPEDIC CENTER, P.C.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 601 HARVEY ST
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City | RADFORD
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State | VA
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Zip | 24141-2339
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Country | US
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Telephone | 540-639-9315
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Fax | 540-731-0860
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Provider Business Mailing Address
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Address Line | 601 HARVEY ST
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City | RADFORD
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State | VA
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Zip | 24141-2339
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Country | US
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Telephone | 540-639-9315
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Fax | 540-731-0860
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH W GRAY
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Credential | MD
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Telephone | 540-639-9315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101036314
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License Number State | VA
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