Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 22710 | NC |
Y | 111NI0900X | Internist | 22710 | NC |
N | 207RG0300X | Geriatric Medicine | 22710 | NC |
NPI | 1164424420 |
---|---|
Provider Name | Stephen D Ertischek |
First Address | Oxford, NC 27565-2571 |
Second Address | Oxford, NC 27565-2571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 30/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30770 | BCBSNC INDIVIDUAL (01) | NC |
8930770 | (05) | NC |
D62852 | (02) | NC |