Individual
DR. JOHN K SOUTHARD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1345B WESTGATE CENTER DR, WINSTON-SALEM, NC 27103-2934
(336) 768-1280
(336) 760-8443
Mailing address
1345B WESTGATE CENTER DR, WINSTON-SALEM, NC 27103-2934
(336) 768-1280
(336) 760-8443
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18576
NC
207N00000X
Dermatology Physician
18576
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89013U8
—
NC
05
—
Q18576
—
SC
Enumeration date
10/05/2005
Last updated
04/08/2009
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