Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 200001287 | NC |
Y | 208600000X | Surgeon | 200001287 | NC |
N | 2086S0102X | Surgical Critical Care | 200001287 | NC |
N | 2086X0206X | Surgical Oncologist | 200001287 | NC |
NPI | 1417932575 |
---|---|
Provider Name | Perry Shen |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 12/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1263M | BCBS (01) | |
2004821000 | (05) | WV |
20051995 | RR MEDICARE (01) | |
37161 | PARTNERS (01) | |
7301138 | (05) | VA |
7354316 | AETNA (01) | |
891263M | (05) | NC |
99591 | MEDCOST (01) | |
G91597 | (02) |