Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | NC | |
N | 208600000X | Surgeon | NC | |
N | 2086S0127X | Trauma Surgeon | NC | |
N | 2086S0129X | Vascular Surgeon | NC |
NPI | 1407965437 |
---|---|
Provider Name | Dr. Dale William Oller |
First Address | Raleigh, NC 27610-1247 |
Second Address | Raleigh, NC 27610-1247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8964068 | (05) | NC |
C85829 | (02) |