NPI | 1720489818 |
---|---|
Entity Type | Organization |
Authorized Contact | TYLER K HAGAN Sole Member 252-633-3400 |
Organization Subpart ? | No |
Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 617) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 617) |
213ES0131X Podiatrist Foot Surgery (Licence: NC 617) | |
Enumeration Date | 2014-09-09 |
Last Update Date | 2014-12-04 |