Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO02839 | NC |
NPI | 1487720090 |
---|---|
Provider Name | Mr. Andrew Owen Ingram |
First Address | Laurinburg, NC 28352-5510 |
Second Address | Laurinburg, NC 28352-5510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795208 | (05) | NC |