Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 2010-00914 | NC |
Y | 2080P0204X | Pediatric Emergency Doctor | 2010-00914 | NC |
NPI | 1497804603 |
---|---|
Provider Name | Dr. Thomas Davis Miller III |
First Address | Charlotte, NC 28211-0035 |
Second Address | Fayetteville, NC 28304-3424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 06/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1497804603 | (05) | NC |