Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 35210 | NC |
NPI | 1043237472 |
---|---|
Provider Name | Stephen Alan South |
First Address | Greensboro, NC 27415-4944 |
Second Address | Greensboro, NC 27405-3669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
897844A | (05) | NC |
F24892 | (02) |