Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 35305 | NC |
NPI | 1023220522 |
---|---|
Provider Name | Dr. Andrew John Cracker |
First Address | Chapel Hill, NC 27514 |
Second Address | Raleigh, NC 27606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F30183 | (02) |