Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 22488 | NC |
NPI | 1063407146 |
---|---|
Provider Name | Houston Magill Kimbrough JR. |
First Address | Greensboro, NC 27403-1157 |
Second Address | Greensboro, NC 27403-1157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 11/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
48975 | BCBS INDIVIDUAL NUMBER (01) | NC |
8948975 | (05) | NC |
C84924 | (02) | NC |