Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 39284 | NC |
NPI | 1629114137 |
---|---|
Provider Name | Dr. Robert Clayton Jarchow |
First Address | Concord, NC 28025-2911 |
Second Address | Concord, NC 28025-2911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 16/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
890183R | (05) | NC |
E56613 | (02) | NC |