Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 23705 | NC |
N | 207Q00000X | Family Doctor | 23705 | NC |
NPI | 1003800335 |
---|---|
Provider Name | Philip David Green |
First Address | New Bern, NC 28561-2248 |
Second Address | New Bern, NC 28562-5248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 01/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1036C | BLUE CROSS (01) | NC |
891036C | (05) | NC |
E16413 | (02) | NC |