Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1003964867 |
---|---|
Provider Name | Mitchel Paul Sugg |
First Address | Kinston, NC 28503-1495 |
Second Address | Kinston, NC 28504-8859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 27/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1861626723 | BCBS (TRAD, PPO, MC) (01) | NC |
1861626723 | PARTNERS (BCBS) (01) | NC |
7705029 | (05) | NC |
7795129 | (05) | NC |