Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 9800825 | NC |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 98-00925 | NC |
NPI | 1043274335 |
---|---|
Provider Name | Mr. William Lewis Craig III |
First Address | Charlotte, NC 28209-3239 |
Second Address | Winston-Salem, NC 27103-6946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 11/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
891157G | (05) | NC |
G84048 | (02) | NC |