Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 201002101 | NC |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 201002101 | NC |
N | 208000000X | Pediatrician | 2010-02101 | NC |
NPI | 1366583213 |
---|---|
Provider Name | Ole A Raustol |
First Address | Charlotte, NC 28260-2373 |
Second Address | Asheville, NC 28803-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366583213 | (05) | VA |
5906059 | (05) | NC |