Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 676 | NC |
NPI | 1588084982 |
---|---|
Provider Name | Ythan Webster |
First Address | Charlotte, NC 28260-0447 |
Second Address | Winston Salem, NC 27103-2936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 27/10/2020 |