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Individual

JON C TER POORTEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
335 PENNY LN, CONCORD, NC 28025-1221
(704) 784-5901
(704) 721-0413
Mailing address
335 PENNY LN, CONCORD, NC 28025-1221
(704) 784-5901
(702) 721-0413

Taxonomy

Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
2000-00323
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
70014929
MEDICARE RAILROAD
NC
05
89126RR
NC
Enumeration date
12/21/2005
Last updated
02/12/2009
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