Individual
MR. CLANCY CONDE LAIZURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
7839 SPENCER BROOK DR, SUMMERFIELD, NC 27358-9305
(336) 644-9393
(336) 644-9393
Mailing address
7839 SPENCER BROOK DR, SUMMERFIELD, NC 27358-9305
(336) 644-9393
(336) 644-9393
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
100970
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8935134
—
NC
Enumeration date
06/24/2006
Last updated
07/08/2007
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