Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 2011-00770 | NC |
NPI | 1316112667 |
---|---|
Provider Name | Dr. Justin Eric Paulson |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-3736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 11/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1316112667 | (05) | NC |
19EX0 | BCBS NC (01) | NC |