Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 200500157 | NC |
NPI | 1053351965 |
---|---|
Provider Name | Dwight D Bates |
First Address | High Point, NC 27262-7008 |
Second Address | Greensboro, NC 27401-1039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 14/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11110B | (02) | |
5904651 | (05) | NC |