Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11571 | NC |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 11571 | NC |
NPI | 1144273244 |
---|---|
Provider Name | James Jerome Pence JR. |
First Address | Wilmington, NC 28409-2054 |
Second Address | Wilmington, NC 28409-2054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 12/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8966744 | (05) | NC |