Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 2018-01304 | NC |
NPI | 1013335629 |
---|---|
Provider Name | Jason Bethea |
First Address | Charlotte, NC 28260-0447 |
Second Address | Matthews, NC 28105-5403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 11/06/2021 |