Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2006-01019 | NC |
Y | 208600000X | Surgeon | 2006-01019 | NC |
N | 2086S0129X | Vascular Surgeon | 2006-01019 | NC |
NPI | 1073534897 |
---|---|
Provider Name | Jason S Dew |
First Address | Burlington, NC 27215-8700 |
Second Address | Burlington, NC 27215-9480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 17/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5905912 | (05) | NC |
I70878 | (02) | NC |