Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist |
NPI | 1033267877 |
---|---|
Provider Name | Mr. Brian Prout |
First Address | Raleigh, NC 27604-3659 |
Second Address | Raleigh, NC 27604-3659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 29/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0414L | BCBS (01) | NC |
7702039 | (05) | NC |
7704336 | (05) | NC |
7795148 | (05) | NC |