Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 9400493 | NC |
NPI | 1033112081 |
---|---|
Provider Name | Dr. John Patrick Fogarty |
First Address | Greenville, NC 27834-5704 |
Second Address | Greenville, NC 27834-5704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 09/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7932860 | (05) | NC |
F83812 | (02) | NC |