Individual
EDOUARD MISSE'
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
700 ACADEMY ST S, AHOSKIE, NC 27910-3264
(252) 209-5404
(252) 209-3490
Mailing address
PO BOX 1385, AHOSKIE, NC 27910-1385
(252) 209-5404
(252) 209-3490
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD039134L
NC
174400000X
Specialist
PA200100577
PA
208600000X
Surgery Physician
Primary
200100577
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129V4
BLUECROSS BLUESHIELD
NC
05
—
89129V4
—
NC
Enumeration date
12/30/2005
Last updated
02/14/2014
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