Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 17530 | SC |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 31440 | NC |
NPI | 1023048022 |
---|---|
Provider Name | William Bockenek |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28203-5814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 27/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E42366 | (02) | NC |