Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2016-00883 | NC |
Y | 208600000X | Surgeon | 2016-00883 | NC |
N | 208200000X | Surgeon | OT014098 | PA |
N | 208600000X | Surgeon | OT014098 | PA |
NPI | 1013295195 |
---|---|
Provider Name | Baker Henson |
First Address | Charlotte, NC 28260-2658 |
Second Address | Hickory, NC 28601-5057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2011 |
Last Update Date | 05/10/2016 |