Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1962 | NC |
NPI | 1003805565 |
---|---|
Provider Name | Dr. Bruce Alan Pate |
First Address | Durham, NC 27705-2579 |
Second Address | Durham, NC 27705-2579 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
093TX | BCBS (01) | NC |
5901433 | (05) | NC |
U88625 | (02) |