Individual
LARRY A WIDNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
624 QUAKER LN, SUITE 117-B, HIGH POINT, NC 27262-3832
(336) 882-1416
(336) 882-7691
Mailing address
PO BOX 5007, HIGH POINT, NC 27262-5007
(336) 882-1416
(336) 882-7691
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
28380
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87271
BCBSNC
NC
05
—
8987271
—
NC
Enumeration date
01/09/2006
Last updated
07/08/2007
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