Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101259100 | VA |
N | 207T00000X | Neurosurgeon | 2011-01173 | NC |
NPI | 1023094950 |
---|---|
Provider Name | Wilson P Daugherty |
First Address | Norfolk, VA 23510-1065 |
Second Address | Norfolk, VA 23510-1065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 10/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I41886 | (02) |