Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 058038 | GA |
Y | 2081P2900X | Pain Medicine | 200700587 | NC |
NPI | 1174696363 |
---|---|
Provider Name | Dr. Rachid Idrissi |
First Address | Benson, NC 27504-1177 |
Second Address | Benson, NC 27504-1177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 04/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5909173 | (05) | NC |