Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | P024529 | NC |
NPI | 1205319050 |
---|---|
Provider Name | Mr. Leon Bass JR. |
First Address | Richlands, NC 28574-8161 |
Second Address | Southport, NC 28461-7800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2018 |
Last Update Date | 07/09/2018 |