Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 39705 | NC |
Y | 208600000X | Surgeon | 39705 | NC |
NPI | 1013948421 |
---|---|
Provider Name | Michael Anthony Tyner |
First Address | Charlotte, NC 28260-2195 |
Second Address | Cary, NC 27511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 02/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013948421 | (05) | NC |
B91962 | (02) |