Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 337 | NC |
Y | 222Z00000X | Podiatrist | 337 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 337 | NC |
NPI | 1013138528 |
---|---|
Provider Name | Dr. John P Miketa |
First Address | Fuquay Varina, NC 27526-1933 |
Second Address | Fuquay Varina, NC 27526-1933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 04/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7908110 | (05) | NC |
U36295 | (02) | NC |