MEDICARE: DR. JAMES GORDON STILL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	25191	NC
2	208000000X	Pediatrics Physician	0101032803	VA

General Provider Information

NPI Number	:	1801041157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES GORDON STILL M.D.

Provider Business Mailing Address
First Line	:	4816 OAK WAY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-6346
Country	:	US
Telephone Number	:	919-848-8227
Fax Number	:

Provider Business Practice Location Address
First Line	:	4816 OAK WAY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-6346
Country	:	US
Telephone Number	:	919-848-8227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2008
Last Update Date	:	11/28/2008

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