Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 15165 | NC |
NPI | 1497852917 |
---|---|
Provider Name | Mr. Marshall Simms Redding |
First Address | Elizabeth City, NC 27909 |
Second Address | Elizabeth City, NC 27909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2006 |
Last Update Date | 11/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8970745 | (05) | NC |
C47645 | (02) | NC |