Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 9900207 | NC |
NPI | 1306822424 |
---|---|
Provider Name | Mr. James Dimuzio JR. |
First Address | Whiteville, NC 28472 |
Second Address | Whiteville, NC 28472 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 26/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
841282A | (05) | NC |
G84842 | (02) |