Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2020-03281 | NC |
NPI | 1003279704 |
---|---|
Provider Name | Dr. Louis Bruno Fornage |
First Address | Morrisville, NC 27560-0077 |
Second Address | Kernersville, NC 27284-7146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 29/07/2020 |