Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 31693 | NC |
Y | 2080P0210X | Pediatric Nephrologist | 31693 | NC |
NPI | 1891858676 |
---|---|
Provider Name | Delbert Wigfall |
First Address | Durham, NC 27710-0001 |
Second Address | Durham, NC 27710-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 07/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8987349 | (05) | NC |
C89598 | (02) |