Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 6700 | SC |
Y | 2086S0105X | Surgery of the Hand | 6700 | SC |
NPI | 1952324063 |
---|---|
Provider Name | Dr. Gerald J Shealy |
First Address | Charlotte, NC 28275-1649 |
Second Address | Charleston, SC 29407-8702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 20/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067000 | (05) | SC |
D17914 | (02) | SC |