Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 2006-01048 | NC |
NPI | 1053428326 |
---|---|
Provider Name | Ali Reza Zomorodi |
First Address | Durham, NC 27704-2121 |
Second Address | Durham, NC 27710-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 25/06/2008 |