Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 9500553 | NC |
NPI | 1518242353 |
---|---|
Provider Name | Dr. G Paul Derosa |
First Address | Durham, NC 27712-9779 |
Second Address | Chapel Hill, NC 27514-1585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2011 |
Last Update Date | 25/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B08717 | (02) | NC |