Provider Demographics
NPI:1174519037
Name:ROYALL, JOHN DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:ROYALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 AVE OF TWO RIVERS
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1802
Mailing Address - Country:US
Mailing Address - Phone:732-747-0591
Mailing Address - Fax:732-747-8343
Practice Address - Street 1:108 AVE OF TWO RIVERS
Practice Address - Street 2:
Practice Address - City:RUMSON
Practice Address - State:NJ
Practice Address - Zip Code:07760-1802
Practice Address - Country:US
Practice Address - Phone:732-747-0591
Practice Address - Fax:732-747-8343
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03272600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2223150101OtherUNITED HEALTHCARE
NJ855366OtherAETNA
NJOK1596OtherPHYSICANS HEALTH SERVICE
NJJ007490OtherTRICARE
NJP2097550OtherOXFORD HEALTH PLAN
NJ222315102002OtherCIGNA
NJ222315102OtherHORIZON BCBS
NJ2990202Medicaid
NJ222315102002OtherCIGNA
NJC56213Medicare UPIN