Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 263 | NC |
Y | 222Z00000X | Podiatrist | 263 | NC |
N | 213EP1101X | Primary Podiatric Medicine | 263 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 263 | NC |
N | 213ES0131X | Foot Surgery | 263 | NC |
NPI | 1447256052 |
---|---|
Provider Name | Dr. Walter Joy Falardeau III |
First Address | Concord, NC 28025-2911 |
Second Address | Mount Airy, NC 27030-4010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 26/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
890807G | (05) | NC |
T64103 | (02) | NC |