Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 2013-01542 | NC |
N | 2086S0120X | Pediatric Surgery | 35060022S | OH |
NPI | 1265499206 |
---|---|
Provider Name | Anthony Stallion |
First Address | Charlotte, NC 28260-1888 |
Second Address | Concord, NC 28025-2966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 06/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0803198 | (05) | OH |
1265499206 | (05) | NC |
G45587 | (02) | OH |
Q0154E | (05) | SC |