Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 36826 | NC |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 36826 | NC |
NPI | 1497737332 |
---|---|
Provider Name | Dr. Edwin James Sebold |
First Address | Charlotte, NC 28209-3239 |
Second Address | Charlotte, NC 28207-1219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 30/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8975148 | (05) | NC |
D93763 | (02) | NC |
N36826 | (05) | SC |