Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 93-00115 | NC |
NPI | 1922161793 |
---|---|
Provider Name | John Foreman |
First Address | Durham, NC 27710-0001 |
Second Address | Durham, NC 27710-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 11/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8933051 | (05) | NC |
F59061 | (02) |