Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 22303 | NC |
NPI | 1003856287 |
---|---|
Provider Name | William Dana Haithcock |
First Address | Fayetteville, NC 28304-3688 |
Second Address | Fayetteville, NC 28304-3688 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8938261 | (05) | NC |
C84263 | (02) |