Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 9901439 | NC |
NPI | 1083697395 |
---|---|
Provider Name | Dr. Jeffrey Thomas Mcclung |
First Address | Greensboro, NC 27410-8802 |
Second Address | Greensboro, NC 27410-8802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89129P5 | (05) | NC |
H41785 | (02) | NC |