Provider Demographics
NPI:1366853145
Name:PHERSON, MICAH JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:JAMES
Last Name:PHERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4414 LAKE BOONE TRL STE 505
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7521
Mailing Address - Country:US
Mailing Address - Phone:919-784-2300
Mailing Address - Fax:919-784-2301
Practice Address - Street 1:4414 LAKE BOONE TRL STE 505
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7521
Practice Address - Country:US
Practice Address - Phone:919-784-2300
Practice Address - Fax:919-784-2301
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-011692086S0129X, 208600000X
NC248398390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program