Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 243298 | MA |
N | 208600000X | Surgeon | 243298 | MA |
Y | 2086S0102X | Surgical Critical Care | 243298 | MA |
N | 2086S0127X | Trauma Surgeon | 2018-02184 | NC |
NPI | 1265657464 |
---|---|
Provider Name | Dr. George Kasotakis |
First Address | Durham, NC 27710-0001 |
Second Address | Durham, NC 27710-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 07/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110088684A | (05) | MA |