Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 24197 | NC |
NPI | 1013921691 |
---|---|
Provider Name | Leighton Alvin Raynor |
First Address | Morganton, NC 28655-5112 |
Second Address | Morganton, NC 28655-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 17/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70704 | BLUE CROSS BLUE SHIELD NC (01) | NC |
8970704 | (05) | NC |
C86114 | (02) |