Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 114732 | NC |
NPI | 1184646580 |
---|---|
Provider Name | Dr. John Herman Wright JR. |
First Address | Winston Salem, NC 27103-6984 |
Second Address | Winston Salem, NC 27103-6972 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 13/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89449 | NC BLUE CROSS BLUE SHIELD (01) | NC |