Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | P20196 | NC |
Y | 213ES0000X | Sports Medicine | P20196 | NC |
NPI | 1073047759 |
---|---|
Provider Name | Jacob Deese |
First Address | Marshville, NC 28103-9606 |
Second Address | Pineville, NC 28134-9336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2017 |
Last Update Date | 09/02/2021 |