Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 31256 | SC |
Y | 2080P0216X | Pediatric Rheumatologist | 31256 | SC |
NPI | 1710907829 |
---|---|
Provider Name | Murray Howard Passo |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 21/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31256 | MEDICAL LICENSE (01) | SC |
312566 | (05) | SC |
AA30572389 | (02) | SC |