Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 200400256 | NC |
N | 111NI0900X | Internist | 200400256 | NC |
Y | 207RH0002X | Hospice and Palliative Medicine | 200400256 | NC |
NPI | 1043204449 |
---|---|
Provider Name | Kenton Sanders |
First Address | Wilmington, NC 28401-7335 |
Second Address | Wilmington, NC 28401-7335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 13/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13632 | BC/BS OF NC (01) | NC |
8913632 | (05) | NC |