Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 33642 | NC |
NPI | 1144594540 |
---|---|
Provider Name | Dr. Richard John Dwane |
First Address | Durham, NC 27717-2360 |
Second Address | Durham, NC 27705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2012 |
Last Update Date | 02/03/2012 |