Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 176 | NC |
N | 213ES0131X | Foot Surgery | 176 | NC |
NPI | 1568542181 |
---|---|
Provider Name | Dr. Robert Charles Wingate |
First Address | Winston Salem, NC 27103 |
Second Address | Winston Salem, NC 27103-9788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 26/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08197 | BCBS (01) | NC |
8908197 | (05) | NC |
T64049 | (02) |