Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35982 | NC |
N | 207XS0117X | Orthopaedic Spine Surgeon | 35982 | NC |
NPI | 1134185697 |
---|---|
Provider Name | Dr. Timothy Wade Mcgowen |
First Address | Charlotte, NC 28209-3239 |
Second Address | Winston-Salem, NC 27103-6946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 04/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89-56721 | (05) | NC |
E99431 | (02) | NC |