Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 11932 | NC |
Y | 213EG0000X | General Practice | 11932 | NC |
NPI | 1003434044 |
---|---|
Provider Name | Brayden Michael Flake |
First Address | Elizabeth City, NC 27909-4363 |
Second Address | Elizabeth City, NC 27909-4363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 07/07/2020 |