Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 27377 | NC |
NPI | 1396843132 |
---|---|
Provider Name | Khaled F Jreisat |
First Address | Jacksonville, NC 28546-3221 |
Second Address | Wilmington, NC 28403-6751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 29/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89133VH | (05) | NC |