Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 23776 | NC |
Y | 208600000X | Surgeon | 23776 | NC |
NPI | 1013948025 |
---|---|
Provider Name | Kenneth Castles Shull |
First Address | High Point, NC 27262-7254 |
Second Address | High Point, NC 27262-7369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 23/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020053940 | RR MEDICARE (01) | NC |
8912533 | (05) | NC |
C86435 | (02) |