Provider Demographics
NPI:1497843486
Name:PASS, MICHAEL WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:PASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1272 EAST STREET
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3437
Mailing Address - Country:US
Mailing Address - Phone:828-456-3511
Mailing Address - Fax:828-456-3583
Practice Address - Street 1:1272 EAST STREET
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3437
Practice Address - Country:US
Practice Address - Phone:828-456-3511
Practice Address - Fax:828-456-3583
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC65796OtherBCBS
NC8965796Medicaid
NC8965796Medicaid
NC209437Medicare PIN