Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 218190 | NC |
NPI | 1013371426 |
---|---|
Provider Name | Brian Zachary Hedges |
First Address | Charlotte, NC 28203-5812 |
Second Address | Charlotte, NC 28203-5812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2016 |
Last Update Date | 12/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
218190 | NORTH CAROLINA MEDICAL BOARD RTL FILE ID # (01) | NC |