Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 35857 | NC |
NPI | 1023194479 |
---|---|
Provider Name | Mr. Dwayne Dennis Callwood |
First Address | Burlington, NC 27216-0209 |
Second Address | Burlington, NC 27215-8700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2006 |
Last Update Date | 07/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20860 | BCBS (01) | NC |
69723 | MEDCOST (01) | NC |
7116 | PARTNERS (01) | NC |
7920860 | (05) | NC |
E73616 | (02) |