Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO01732 | |
N | 222Z00000X | Podiatrist | CPO01732 | |
Y | 224P00000X | Prosthetist | CPO01732 | |
N | 225000000X | Orthotic Fitter | 1732 | NC |
NPI | 1861729782 |
---|---|
Provider Name | Mr. Larry William Morton |
First Address | Greensboro, NC 27405-3382 |
Second Address | Matthews, NC 28105-4985 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2009 |
Last Update Date | 06/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795139 | (05) | NC |