Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 98-00033 | NC |
Y | 208600000X | Surgeon | 98-00033 | NC |
NPI | 1013974153 |
---|---|
Provider Name | Kim Leigh Crosby |
First Address | Gastonia, NC 28054 |
Second Address | Gastonia, NC 28054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 15/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G69117 | (02) | NC |