Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 9800591 | NC |
NPI | 1033195144 |
---|---|
Provider Name | Mr. Erik L Kenyon |
First Address | Whiteville, NC 28472-3601 |
Second Address | Whiteville, NC 28472-3601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 16/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8911444 | (05) | NC |
G70377 | (02) |