Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO02116 | NC |
N | 222Z00000X | Podiatrist | CPO02116 | NC |
Y | 224P00000X | Prosthetist | CPO02116 | NC |
NPI | 1376663534 |
---|---|
Provider Name | Mr. Travis L Dessoffy |
First Address | Greenville, NC 27834-5805 |
Second Address | Greenville, NC 27834-5278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 18/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1376663534 | (05) | NC |