Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 2009-00067 | NC |
N | 208D00000X | General Practice Physician | 2009-00067 | NC |
NPI | 1467469320 |
---|---|
Provider Name | Dr. Kent Seitz |
First Address | Charlotte, NC 28270 |
Second Address | Charlotte, NC 28270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 24/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
266406200 | (05) | FL |
5914829 | (05) | NC |
C76137 | (02) | NC |