Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2005-01876 | NC |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 2005-01876 | NC |
NPI | 1104873454 |
---|---|
Provider Name | Jason Patrick Norcross |
First Address | Charlotte, NC 28209-3239 |
Second Address | Hickory, NC 28602-1363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 13/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5905846 | (05) | NC |
BN9613818 | DEA NUMBER (01) | NC |
I54995 | (02) | NC |