Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 388 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 388 | NC |
N | 213ES0131X | Foot Surgery | 388 | NC |
NPI | 1164425013 |
---|---|
Provider Name | Dr. Thurmond Eric Siceloff |
First Address | Clemmons, NC 27012-9379 |
Second Address | Clemmons, NC 27012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 15/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164425013 | (05) | NC |
7908019 | (05) | NC |
NCH360B699 | MEDICARE (01) | NC |
P01909015 | RAILROAD MEDICARE (01) | NC |
U66587 | (02) |