Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 35741 | NC |
NPI | 1063547255 |
---|---|
Provider Name | Dr. George Lacrusie Saunders III |
First Address | Supply, NC 28462-0029 |
Second Address | Calabash, NC 28467-9820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 04/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080047334 | MEDICARE RAILROAD (01) | NC |
76588 | INDIVIDUAL BCBS (01) | NC |
8974601 | (05) | NC |
D51108 | (02) | NC |