Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2007017281 | MO |
N | 111NI0900X | Internist | 2007017281 | MO |
N | 207R00000X | Internist | 2011-00653 | NC |
N | 111NI0900X | Internist | 2011-00653 | NC |
Y | 207RH0002X | Hospice and Palliative Medicine | 2011-00653 | NC |
NPI | 1366647067 |
---|---|
Provider Name | Dr. Randall E Schisler JR. |
First Address | Charlotte, NC 28260-0447 |
Second Address | Winston Salem, NC 27103-3013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366647067 | (05) | NC |
5918801 | (05) | NC |
Q0065R | (05) | SC |