Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 9400084 | NC |
NPI | 1043296130 |
---|---|
Provider Name | Douglas Jeffery |
First Address | Statesville, NC 28687-1845 |
Second Address | Mooresville, NC 28117-5609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 03/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8945871 | (05) | NC |
E81814 | (02) | |
P00912470 | RR MEDICARE (01) | NC |