Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5107 | NC |
NPI | 1073725727 |
---|---|
Provider Name | Dr. Philip W Shoemaker |
First Address | Raleigh, NC 27615-1901 |
Second Address | Raleigh, NC 27615-5386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |