Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2009-00592 | NC |
N | 207QA0401X | Family Doctor - Addiction Medicine | 240408 | NY |
NPI | 1497885354 |
---|---|
Provider Name | Surah Grumet |
First Address | Durham, NC 27713-1869 |
Second Address | Durham, NC 27713-1869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 20/09/2013 |