Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 19679 | NC |
NPI | 1043328297 |
---|---|
Provider Name | William Credle |
First Address | Wilmington, NC 28401-7307 |
Second Address | Wilmington, NC 28401-7307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 05/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110123227 | RAILROAD MEDICARE (01) | NC |
25530 | BCBS NC (01) | NC |
8925530 | (05) | NC |
C83382 | (02) | NC |