Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2018-00089 | NC |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2018-00089 | NC |
NPI | 1225264948 |
---|---|
Provider Name | Jordan Miller Case |
First Address | Winston Salem, NC 27157-1070 |
Second Address | Winston Salem, NC 27157-8668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 19/03/2019 |