Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 2004-00457 | NC |
N | 207RG0100X | Gastroenterologist | 200400457 | NC |
NPI | 1003891094 |
---|---|
Provider Name | Oscar Sven Brann |
First Address | Charlotte, NC 28210-2108 |
Second Address | Charlotte, NC 28287-3893 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003891094 | (05) | NC |
89137A1 | (05) | NC |
H40377 | (02) | NC |
N0045C | (05) | SC |