Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 27878 | NC |
NPI | 1053314062 |
---|---|
Provider Name | Dr. Richard Mann |
First Address | Greenville, NC 27834-5704 |
Second Address | Greenville, NC 27834-5704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8953866 | (05) | NC |
C85299 | (02) | NC |