Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 24519 | NC |
NPI | 1073593943 |
---|---|
Provider Name | Mr. Ronald Bernard Shealy |
First Address | Winston Salem, NC 27103-1522 |
Second Address | Winston Salem, NC 27103-1522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 15/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040011654 | RAILROAD MEDICARE (01) | NC |
1000673 | UNITED HEALTHCARE (01) | NC |
30636 | MEDCOST (01) | NC |
391 | PARTNERS (01) | NC |
6525253 | VIRGINIA MEDICAID (01) | VA |
75581 | BLUE CROSS BLUE SHIELD (01) | NC |
7975581 | (05) | NC |
D33174 | (02) | NC |