Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 29112 | NC |
NPI | 1336124981 |
---|---|
Provider Name | Laurence Bruce Givner |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 08/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2007292000 | (05) | WV |
35331 | MEDCOST (01) | |
35669 | BCBS (01) | |
5741 | PARTNERS (01) | |
6722407 | (05) | VA |
7315733 | AETNA (01) | |
8935669 | (05) | NC |
C84075 | (02) | |
Q29112 | (05) | SC |