Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2009-00158 | NC |
N | 208600000X | Surgeon | 2009-00158 | NC |
Y | 2086S0129X | Vascular Surgeon | 2009-00158 | NC |
NPI | 1134174436 |
---|---|
Provider Name | Dr. James N. Antezana |
First Address | Charlotte, NC 28210-8475 |
Second Address | Charlotte, NC 28210-8469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 30/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I51820 | (02) | NC |