Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 9506 | NC |
NPI | 1003228784 |
---|---|
Provider Name | Dr. Travis Joe Whitley |
First Address | Chapel Hill, NC 27599-0001 |
Second Address | Chapel Hill, NC 27599-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2014 |
Last Update Date | 29/05/2014 |