Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 200700639 | NC |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 200700639 | NC |
NPI | 1114066784 |
---|---|
Provider Name | Dr. Jonathan D Chappell |
First Address | Raleigh, NC 27604-0010 |
Second Address | Raleigh, NC 27610-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 17/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2007-00639 | NC MEDICAL LICENSE (01) | NC |
A95831 | LICENSE (01) | CA |