Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2016-01284 | NC |
NPI | 1003250481 |
---|---|
Provider Name | John P Bernot |
First Address | Charlotte, NC 28260-2658 |
Second Address | Winston Salem, NC 27106-4817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2013 |
Last Update Date | 06/01/2017 |