Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2009-00745 | NC |
Y | 2080P0214X | Pediatric Pulmonologist | 2009-00745 | NC |
NPI | 1295996213 |
---|---|
Provider Name | Dr. William Isler Wooten III |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-3736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 15/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
171GG | BCBSNC (01) | NC |
5920695 | (05) | NC |