Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2798 | NC |
NPI | 1144307398 |
---|---|
Provider Name | Dr. Thomas P Mckay JR. |
First Address | Pinebluff, NC 28373-8020 |
Second Address | Southern Pines, NC 28387 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U79994 | (02) | NC |