Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 200400490 | NC |
Y | 208600000X | Surgeon | 200400490 | NC |
NPI | 1013991579 |
---|---|
Provider Name | Lance Diehl |
First Address | Charlotte, NC 28219-9305 |
Second Address | Monroe, NC 28112-5086 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H40851 | (02) | NC |