Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 29381 | NC |
NPI | 1114923679 |
---|---|
Provider Name | Lee Ann Roberts |
First Address | Raleigh, NC 27612-2310 |
Second Address | Raleigh, NC 27612-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C86831 | (02) |