Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 200300154 | NC |
NPI | 1891958229 |
---|---|
Provider Name | Mr. Gregory Allen Garth |
First Address | Boone, NC 28607-4917 |
Second Address | Boone, NC 28607-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 07/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89133C6 | (05) | NC |
F44199 | (02) |