Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 200401199 | NC |
N | 207RP1001X | Pulmonary Disease | 200401199 | NC |
N | 207RS0012X | Sleep Medicine | 200401199 | NC |
NPI | 1003851395 |
---|---|
Provider Name | Dr. David Defeo |
First Address | Winston Salem, NC 27103-4007 |
Second Address | Winston Salem, NC 27103-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45586U | (02) | NC |