Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 35259 | NC |
NPI | 1003853821 |
---|---|
Provider Name | Don Robert Bahner JR. |
First Address | Southern Pines, NC 28387-6819 |
Second Address | Pinehurst, NC 28374-8710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8912498 | (05) | NC |
E59054 | (02) | NC |