Individual
EDWARD GALE LOY TAUTJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 HAWTHORNE LN, CHARLOTTE, NC 28204-2515
(704) 384-5416
(704) 384-5992
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-5416
(704) 384-5992
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
009701614
NC
208M00000X
Hospitalist Physician
Primary
9701614
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195808
—
SC
05
—
891354Y
—
NC
Enumeration date
08/09/2005
Last updated
02/08/2023
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