Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 8448 | NC |
Y | 1223G0001X | General Practice | 8448 | NC |
Y | 213EG0000X | General Practice | 8448 | NC |
NPI | 1184722266 |
---|---|
Provider Name | Dr. Phillip Joseph Kohut |
First Address | Wallace, NC 28466-9272 |
Second Address | Faison, NC 28341-8820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 20/06/2013 |