Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0027452 | NC |
Y | 208600000X | Surgeon | 0027452 | NC |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 0027452 | NC |
NPI | 1053311852 |
---|---|
Provider Name | Dr. Kirk Berry Faust |
First Address | Raleigh, NC 27607-6476 |
Second Address | Raleigh, NC 27607-6476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 05/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31422 | BCBS (01) | NC |
C83715 | (02) |