Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 94-01088 | NC |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 94-01088 | NC |
NPI | 1043294598 |
---|---|
Provider Name | Dr. John Michael Wattenbarger |
First Address | Charlotte, NC 28209-3239 |
Second Address | Charlotte, NC 28207-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 12/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8985857 | (05) | NC |
F83810 | (02) | NC |