Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 9500379 | NC |
NPI | 1053374157 |
---|---|
Provider Name | David Kishbaugh |
First Address | Fayetteville, NC 28309-1054 |
Second Address | Fayetteville, NC 28304-3571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 11/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8949528 | (05) | NC |
G07259 | (02) |