Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 25216 | NC |
Y | 2086S0105X | Surgery of the Hand | 25216 | NC |
NPI | 1881697514 |
---|---|
Provider Name | Wallace F Andrew JR. |
First Address | Raleigh, NC 27612-5243 |
Second Address | Raleigh, NC 27612-5243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2005 |
Last Update Date | 04/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C82611 | (02) |