Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | C51530 | |
N | 222Z00000X | Podiatrist | C51530 | |
Y | 224P00000X | Prosthetist | CP03333 |
NPI | 1457889834 |
---|---|
Provider Name | Christian Roberts Been |
First Address | Winston Salem, NC 27103-6710 |
Second Address | Greensboro, NC 27401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2017 |
Last Update Date | 01/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C51530 | THE BOARD OF CERTIFICATION / ACCREDITATION, INTERNATIONAL (01) | |
CP03333 | AMERICAN BOARD OF CERTIFICATION (01) | |
PO000074 | STATE LICENSE (01) | PA |