Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 375 | NC |
NPI | 1063498301 |
---|---|
Provider Name | Stephen A Kinard |
First Address | Raleigh, NC 27620-4759 |
Second Address | Tarboro, NC 27886-4152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0818U | BCBS (01) | NC |
890818U | (05) | NC |
U60495 | (02) | NC |