Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 28261 | NC |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 28261 | NC |
Y | 207VX0000X | Obstetrician | 28261 | NC |
NPI | 1700879699 |
---|---|
Provider Name | Dr. Julius Q Mallette |
First Address | Washington, NC 27889-4906 |
Second Address | Kinston, NC 28501-4933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 04/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160034966 | RAILROAD MEDICARE (01) | NC |
2170961 | MEDICARE (01) | NC |
53777 | BCBS NC (01) | NC |
8953777 | (05) | NC |
C85288 | (02) | NC |