Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 32779 | NC |
NPI | 1003870171 |
---|---|
Provider Name | Kenneth Russell Manning |
First Address | Fayetteville, NC 28309-2935 |
Second Address | Fayetteville, NC 28304-3424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1297E | BCBS (01) | NC |
891297E | (05) | NC |
G16406 | (02) | NC |