Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7575 | NC |
NPI | 1003867524 |
---|---|
Provider Name | Dr. John E Fidler JR. |
First Address | Goldsboro, NC 27534-1789 |
Second Address | Goldsboro, NC 27534-1789 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0160988 | UNITED CONCORDIA (01) | NC |
89902J5 | (05) | NC |
902J5 | BCBS OF NC (01) | NC |
U97342 | (02) | NC |