Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 26036 | NC |
NPI | 1215908736 |
---|---|
Provider Name | Dr. Harold Payne Overcash |
First Address | Raleigh, NC 27607-6678 |
Second Address | Raleigh, NC 27607-6678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127JM | BLUECROSSBLUESHIELD INS # (01) | NC |
89127JM | (05) | NC |
C81860 | (02) | NC |