Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 9300132 | NC |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 9300132 | NC |
N | 207XS0106X | Orthopaedic Hand Surgeon | 9300132 | NC |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 9300132 | NC |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 9300132 | NC |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 9300132 | NC |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 9300132 | NC |
NPI | 1417950825 |
---|---|
Provider Name | Angus Woodward Graham III |
First Address | Charlotte, NC 28260-2373 |
Second Address | Brevard, NC 28712-3897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 09/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2034670B | MEDICARE PTAN (01) | NC |