Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2012-01255 | NC |
N | 207QS0010X | Family Doctor - Sports Medicine | 2012-01255 | NC |
NPI | 1255568309 |
---|---|
Provider Name | Kyle T Pope |
First Address | Charlotte, NC 28260-0447 |
Second Address | Charlotte, NC 28277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 25/10/2020 |