Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 34343 | NC |
Y | 208600000X | Surgeon | 34343 | NC |
N | 2086S0129X | Vascular Surgeon | 34343 | NC |
NPI | 1144214883 |
---|---|
Provider Name | Walter Douglas Harrison |
First Address | Rocky Mount, NC 27804-0200 |
Second Address | Rocky Mount, NC 27804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 30/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10456 | BCBSNC (01) | NC |
20024902 | RAILROAD MEDICARE (01) | NC |
42423 | MEDCOST (01) | NC |
6109936 | CIGNA HEALTHCARE (01) | NC |
8940156 | (05) | NC |
E91145 | (02) | NC |