Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 9901198 | NC |
Y | 208600000X | Surgeon | 9901198 | NC |
N | 2086S0129X | Vascular Surgeon | 9901198 | NC |
NPI | 1033135868 |
---|---|
Provider Name | John P Henretta |
First Address | Indianapolis, IN 46206-1987 |
Second Address | Asheville, NC 28801-4016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12394 | BCBSNC (01) | NC |
8912394 | (05) | NC |