Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 200400421 | NC |
NPI | 1013976646 |
---|---|
Provider Name | David Tat |
First Address | Fayetteville, NC 28304-3425 |
Second Address | Fayetteville, NC 28304-3425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 05/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89137MU | (05) | NC |
I21618 | (02) |