Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 200200559 | NC |
NPI | 1215911698 |
---|---|
Provider Name | Daniel Jeffrey Kirse |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 15/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131FT | BCBS (01) | NC |
2005965000 | (05) | WV |
49043 | PARTNERS (01) | NC |
6737161 | (05) | VA |
7494649 | AETNA (01) | |
89131FT | (05) | NC |
B7060 | MEDCOST (01) | NC |
G67578 | (02) | |
Q0055G | (05) | SC |