Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 39719 | NC |
NPI | 1154303907 |
---|---|
Provider Name | Garret P. Young |
First Address | New Bern, NC 28561-2065 |
Second Address | New Bern, NC 28562-5238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 21/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1141C | BCBS OF NC (01) | NC |
150918 | VYTRA (01) | NC |
153000500 | DOL (01) | NC |
760158 | MAMSI (01) | NC |
891141C | (05) | NC |
C5188 | MEDCOST (01) | NC |
E60537 | (02) | NC |