Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO00968 | NC |
N | 222Z00000X | Podiatrist | CPO00968 | NC |
Y | 224P00000X | Prosthetist | CPO00968 | NC |
NPI | 1306942453 |
---|---|
Provider Name | Harry Pursell Phillips |
First Address | Durham, NC 27704-2150 |
Second Address | Durham, NC 27704-2150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 11/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9190716 | (05) | VA |