Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2006-01250 | NC |
N | 2081P2900X | Pain Medicine | 2006-01250 | NC |
NPI | 1225134679 |
---|---|
Provider Name | Hongtao Michael Guo |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston-Salem, NC 27157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 15/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10385130 | (05) | VA |
143GN | BCBS (01) | |
191653 | MEDCOST (01) | |
3810010511 | (05) | WV |
5906368 | (05) | NC |
7017897 | AETNA (01) | |
808426 | PARTNERS (01) | |
I67973 | (02) | |
Q0140H | (05) | SC |