Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 200200963 | NC |
NPI | 1003828567 |
---|---|
Provider Name | Thomas Broderick Mulford |
First Address | Asheville, NC 28803-3499 |
Second Address | Asheville, NC 28803-3505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 14/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5902946 | (05) | NC |
F38550 | (02) |