Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 23067 | NC |
NPI | 1043285794 |
---|---|
Provider Name | Dr. Clyde Nolan JR. |
First Address | Greensboro, NC 27401-1033 |
Second Address | Greensboro, NC 27401-1033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 10/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8962953 | (05) | NC |
C47681 | (02) | NC |