Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 154 | NC |
Y | 222Z00000X | Podiatrist | 154 | NC |
N | 213EP0504X | Public Medicine | 154 | NC |
N | 213EP1101X | Primary Podiatric Medicine | 154 | NC |
N | 111NR0200X | Radiology | 154 | NC |
N | 213ER0200X | Radiology | 154 | NC |
N | 2081S0010X | Sports Medicine | 154 | NC |
N | 213ES0000X | Sports Medicine | 154 | NC |
N | 213ES0131X | Foot Surgery | 154 | NC |
NPI | 1336238336 |
---|---|
Provider Name | Dr. Bruce G Fawcett |
First Address | Raleigh, NC 27608-2368 |
Second Address | Raleigh, NC 27608-2368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 04/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08064 | BCBS (01) | NC |
1115086015 | CIGNA (01) | NC |
16437 | PARTNERS (01) | NC |
2751610 | UNITED (01) | NC |
4279205 | AETNA (01) | NC |
440912 | OPTIMUM CHOICE (01) | NC |
480017899 | RAILROAD MEDICARE (01) | NC |
561412156 | HUMANA (01) | NC |
7908064 | (05) | NC |
T64044 | (02) | NC |