Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 2015-01370 | NC |
NPI | 1043578453 |
---|---|
Provider Name | Matthew T Mishoe |
First Address | Morganton, NC 28655-4093 |
Second Address | Morganton, NC 28655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 05/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043578453 | (05) | NC |