Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25039 | NC |
Y | 111NI0900X | Internist | 25039 | NC |
N | 207RG0300X | Geriatric Medicine | 25039 | NC |
NPI | 1043279516 |
---|---|
Provider Name | Mr. Dennis Clark Kabasan |
First Address | Flat Rock, NC 28731-9447 |
Second Address | Flat Rock, NC 28731-9447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 09/03/2020 |