Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 9400504 | NC |
N | 208600000X | Surgeon | 9400504 | NC |
N | 2086S0102X | Surgical Critical Care | 9400504 | NC |
Y | 2086S0129X | Vascular Surgeon | 9400504 | NC |
NPI | 1245215300 |
---|---|
Provider Name | Randolph Lee Geary |
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 |
---|---|---|
12524 | PARTNERS (01) | |
2004904000 | (05) | WV |
34990 | BCBS (01) | |
51716 | MEDCOST (01) | |
7302002 | (05) | VA |
7803811 | AETNA (01) | |
7934990 | (05) | NC |
F84710 | (02) | |
Q0050I | (05) | SC |