Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 98-01269 | NC |
N | 207T00000X | Neurosurgeon | MS001 | WV |
NPI | 1073587184 |
---|---|
Provider Name | Takanori Fukushima |
First Address | Raleigh, NC 27609-6800 |
Second Address | Raleigh, NC 27609-6800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 21/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014843200004 | (05) | PA |
0089111000 | (05) | WV |
0129631 | (05) | OH |
1163H | BCBSNC (01) | NC |
699321400 | (05) | MD |
891163H | (05) | NC |
F13012 | (02) | NC |