Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1528335239 |
---|---|
Provider Name | Mr. David A Cloud |
First Address | Fayetteville, NC 28304-3414 |
Second Address | Fayetteville, NC 28304-3414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2011 |
Last Update Date | 23/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0478V | BCBS (01) | NC |
7701177 | (05) | NC |