Doctor Name: | DR. HENRY M. IZURIETA |
NPI Number: | 1023010345 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 17134 |
Business Practice Address: | 1601 Owen Drive Fayetteville, NC - 283043425 |
Business Phone Number: | 9106780100 |
Business Fax Number: | 9106780115 |
Mailing Address: | 1601 Owen Drive, FAYETTEVILLE |
State: | NC |
Postal Code: | 283043425 |
Phone Number: | 9106780100 |
Fax Number: | 9106780115 |
NPI Enumeration Date: | 05/31/2005 |
NPI Last Update Date: | 01/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | 03/20/2006 |
NPI Reactivation Date: | 03/24/2006 |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 17134 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |