Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 200101499 | NC |
N | 208D00000X | General Practice Physician | 2001-01499 | NC |
NPI | 1003891532 |
---|---|
Provider Name | Dr. Jason P. Stopyra |
First Address | Charlotte, NC 28260-2658 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 05/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89135E5 | (05) | NC |
H51999 | (02) |