Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 200001509 | NC |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 200001509 | NC |
NPI | 1528061348 |
---|---|
Provider Name | Keith P Mankin |
First Address | Raleigh, NC 27607-7507 |
Second Address | Raleigh, NC 27607-7507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 22/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1275V | BCBS (01) | NC |
891275V | (05) | NC |
F72443 | (02) |