Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 23592 | SC |
N | 207VE0102X | Reproductive Endocrinologist | 23592 | SC |
Y | 207VE0102X | Reproductive Endocrinologist | 29614 | NC |
NPI | 1477509263 |
---|---|
Provider Name | Bruce Arthur Lessey |
First Address | Winston Salem, NC 27157-0001 |
Second Address | Winston Salem, NC 27103-2508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 30/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APPROVED | (05) | SC |