Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1487622452 |
---|---|
Provider Name | Dr. Jack Tarleton |
First Address | Asheville, NC 28805-1921 |
Second Address | Asheville, NC 28803-2606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 08/07/2007 |