Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO02290 | DE |
N | 222Z00000X | Podiatrist | CPO02290 | DE |
Y | 224P00000X | Prosthetist | CPO02290 | DE |
NPI | 1306163860 |
---|---|
Provider Name | Mr. Randy L Daniel |
First Address | Greenville, NC 27834-5052 |
Second Address | Greenville, NC 27834-5052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2010 |
Last Update Date | 10/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009190511 | (05) | VA |
384410 | BCBS (01) | VA |