Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 40000 | NC |
N | 208000000X | Pediatrician | 40000 | NC |
NPI | 1366467649 |
---|---|
Provider Name | John E Spence |
First Address | Charlotte, NC 28260-1372 |
Second Address | Charlotte, NC 28203-5865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 09/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366467649 | (05) | NC |
78721 | NCBCBS (01) | NC |
8978721 | (05) | NC |
B06678 | (02) | NC |
N40000 | (05) | SC |