Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | ME 70220 | FL |
N | 207R00000X | Internist | ME 70220 | FL |
N | 111NI0900X | Internist | ME 70220 | FL |
Y | 207RR0500X | Rheumatology | 075391 | GA |
N | 207RR0500X | Rheumatology | ME 70220 | FL |
NPI | 1184624876 |
---|---|
Provider Name | Dr. Michael Carver Belcon |
First Address | Augusta, GA 30901-2603 |
Second Address | Augusta, GA 30912-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 18/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28996 | BX (01) | FL |
300947500 | (05) | FL |
70220 | ME (01) | FL |
G26433 | (02) |