Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 200200874 | NC |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 200200874 | NC |
NPI | 1477508893 |
---|---|
Provider Name | Eric D Challgren |
First Address | Raleigh, NC 27607-7511 |
Second Address | Raleigh, NC 27607-7511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H75222 | (02) | NC |